MEDICARE: GENARA N HOLLADAY A.P., PHARM D, MD

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	171100000X	Acupuncturist	AP866	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP866	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1962571638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENARA N HOLLADAY A.P., PHARM D, MD

Provider Business Mailing Address
First Line	:	741 OLD HICKORY RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8803
Country	:	US
Telephone Number	:	904-398-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4741 ATLANTIC BLVD STE E2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-1138
Country	:	US
Telephone Number	:	904-398-6400
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/31/2018

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