Healthcare Provider Details

I. General information

NPI: 1184967697
Provider Name (Legal Business Name): STEPHANIE MCDEARMAN HOLLINGSWORTH R.D., L.D., CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7262
  • Fax: 850-416-7246
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND10488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: