MEDICARE: MRS. JENNIFER MARIE HOLODY NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11001612	FL

General Provider Information

NPI Number	:	1184273443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE HOLODY NP-C

Provider Business Mailing Address
First Line	:	1040 NE 16TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2516
Country	:	US
Telephone Number	:	305-496-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 NE 16TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2516
Country	:	US
Telephone Number	:	305-496-1397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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