1043454853 NPI number — MRS. HOLLY MARIE BOYD N.P.

Table of content: MRS. HOLLY MARIE BOYD N.P. (NPI 1043454853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043454853 NPI number — MRS. HOLLY MARIE BOYD N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
HOLLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043454853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 MARINER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-5680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-666-1200
Provider Business Mailing Address Fax Number:
352-688-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20615 AMBERFIELD DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAND O LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34638-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-949-2950
Provider Business Practice Location Address Fax Number:
813-949-2924
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9220930 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K0197L . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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