Healthcare Provider Details

I. General information

NPI: 1053183160
Provider Name (Legal Business Name): HOLLY DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY ROBERTS

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S HUNT CLUB BLVD
APOPKA FL
32703-4948
US

IV. Provider business mailing address

514 S HUNT CLUB BLVD
APOPKA FL
32703-4948
US

V. Phone/Fax

Practice location:
  • Phone: 407-613-2335
  • Fax:
Mailing address:
  • Phone: 407-613-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: