MEDICARE: HOLLEY S MOULING

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	251E00000X	Home Health Agency		FL
2	374U00000X	Home Health Aide		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710639521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLEY S MOULING

Provider Business Mailing Address
First Line	:	422 W AMELIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-1924
Country	:	US
Telephone Number	:	813-521-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:	813-521-9546
Fax Number	:

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

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	01/21/2026

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Directions to “ HOLLEY S MOULING ” Practice Location

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