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General NPI Number Information
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NPI Number | 1679115190
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Entity Type | Individual
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Provider Name | DR. GEORGINA HOLLENBACH
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Gender | Female
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 119 LARKSPUR DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5208
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Country | US
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Telephone | 321-947-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 119 LARKSPUR DR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5208
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Country | US
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Telephone | 321-947-9691
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 11017308
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9315185
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License Number State | FL
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