Healthcare Provider Details

I. General information

NPI: 1912818725
Provider Name (Legal Business Name): HOLLY CARMODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 OAK NECK RD APT A
CLEARWATER FL
33763-1540
US

IV. Provider business mailing address

2284 OAK NECK RD APT A
CLEARWATER FL
33763-1540
US

V. Phone/Fax

Practice location:
  • Phone: 914-489-5389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11050686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: