Healthcare Provider Details

I. General information

NPI: 1508819848
Provider Name (Legal Business Name): JENNIFER MARY HOLLAND-HINTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARY HOLLAND M.D.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD SUITE 200
NORFOLK VA
23502-3800
US

IV. Provider business mailing address

885 KEMPSVILLE RD SUITE 200
NORFOLK VA
23502-3800
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-6342
  • Fax: 757-963-6158
Mailing address:
  • Phone: 757-461-6342
  • Fax: 757-963-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101052905
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200100699
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: