Healthcare Provider Details

I. General information

NPI: 1548898299
Provider Name (Legal Business Name): HOLLIE MICHELLE MACMULLAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-8266
  • Fax: 813-355-5045
Mailing address:
  • Phone: 813-780-8266
  • Fax: 813-355-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN9442419
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11013043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: