Healthcare Provider Details

I. General information

NPI: 1215013552
Provider Name (Legal Business Name): MINOO H HOLLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 N 9TH AVE STE 103
PENSACOLA FL
32504-8770
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-9000
  • Fax: 850-416-1912
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME68641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: