Healthcare Provider Details

I. General information

NPI: 1518597418
Provider Name (Legal Business Name): HOLLY BRIANNA VANDOREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY BRIANNA TAYLOR

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 W VILLAGE DR UNIT 1533
TAMPA FL
33624-3429
US

IV. Provider business mailing address

4522 W VILLAGE DR UNIT 1533
TAMPA FL
33624-3429
US

V. Phone/Fax

Practice location:
  • Phone: 813-590-3260
  • Fax:
Mailing address:
  • Phone: 813-590-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: