Healthcare Provider Details

I. General information

NPI: 1417698671
Provider Name (Legal Business Name): FLOYD L B HOLLAND JR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

9415 ALBANY CT
ORLAND PARK IL
60467-5635
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-8000
  • Fax: 708-684-1028
Mailing address:
  • Phone: 708-364-7208
  • Fax: 708-949-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28211665A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.030083
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: