=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790713329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI-LINELL COLBY HOLLINS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 03/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8149 POINT MEADOWS WAY
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-9111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-260-0352
-----------------------------------------------------
Fax | 904-363-9818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8149 POINT MEADOWS WAY
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-9111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-260-0352
-----------------------------------------------------
Fax | 904-363-9818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 35-054713
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | ME133900
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------