=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316285166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN HOLLIER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2013
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 SW 13TH ST
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-374-5600
-----------------------------------------------------
Fax | 352-374-5608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 GREENWOOD DR
-----------------------------------------------------
City | JENNINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70546-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-365-8996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN5208397
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------