Healthcare Provider Details

I. General information

NPI: 1578092201
Provider Name (Legal Business Name): RACHEL DALE HOLLENBACH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 BAYMEADOWS RD STE 2
JACKSONVILLE FL
32217-4676
US

IV. Provider business mailing address

9838 OLD BAYMEADOWS RD # 388
JACKSONVILLE FL
32256-8101
US

V. Phone/Fax

Practice location:
  • Phone: 904-332-7431
  • Fax: 904-332-7408
Mailing address:
  • Phone: 904-332-7431
  • Fax: 904-332-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3150732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: