Healthcare Provider Details

I. General information

NPI: 1124868260
Provider Name (Legal Business Name): HOLLY OPITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE STE 402
TAMPA FL
33609-4083
US

IV. Provider business mailing address

2255 GLADES RD STE 228W
BOCA RATON FL
33431-7391
US

V. Phone/Fax

Practice location:
  • Phone: 813-969-1681
  • Fax:
Mailing address:
  • Phone: 561-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11032959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: