MEDICARE: HELAINA DOLLINS

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	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376025965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELAINA DOLLINS

Provider Business Mailing Address
First Line	:	3347 MAGNOLIA SPRINGS DR APT 203
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-0019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 MAGNOLIA SPRINGS DRIVE
Second Line	:	APT 203
City	:	RIVERVIEW
State	:	FL
Zip	:	33578
Country	:	US
Telephone Number	:	757-650-0668
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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