Healthcare Provider Details

I. General information

NPI: 1982168514
Provider Name (Legal Business Name): MRS. JENNIFER M HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 BUD DIAMOND RD
JAY FL
32565-4846
US

IV. Provider business mailing address

2707 BUD DIAMOND RD
JAY FL
32565-4846
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-3961
  • Fax:
Mailing address:
  • Phone: 850-398-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: