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General NPI Number Information
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NPI Number | 1326231762
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Entity Type | Individual
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Provider Name | SHAHLA TABASI HOLLAND AP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 804 NW 16TH AVE SUITE A
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City | GAINESVILLE
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State | FL
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Zip | 32601-4012
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Country | US
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Telephone | 352-379-6171
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Fax | 352-246-9070
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Provider Business Mailing Address
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Address Line | 3403 NE US HIGHWAY 301
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City | HAWTHORNE
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State | FL
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Zip | 32640-2813
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Country | US
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Telephone | 352-475-5772
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Fax | 352-379-6171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP1163
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License Number State | FL
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