Healthcare Provider Details

I. General information

NPI: 1912572165
Provider Name (Legal Business Name): HOLLY KADDOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY BROWN

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR FL 2019
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

204 ATLAS DR
SAINT AUGUSTINE FL
32092-1123
US

V. Phone/Fax

Practice location:
  • Phone: 877-436-8527
  • Fax:
Mailing address:
  • Phone: 904-613-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: