Healthcare Provider Details

I. General information

NPI: 1720772544
Provider Name (Legal Business Name): AUDREY ALINE HOLLINGER ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARSH ISLAND CIR
SAINT AUGUSTINE FL
32095-9644
US

IV. Provider business mailing address

105 MARSH ISLAND CIR
SAINT AUGUSTINE FL
32095-9644
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-6074
  • Fax:
Mailing address:
  • Phone: 904-325-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: