1164500476 NPI number — MARTHA C HOLLEY NP

Table of content: MARTHA C HOLLEY NP (NPI 1164500476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164500476 NPI number — MARTHA C HOLLEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLEY
Provider First Name:
MARTHA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1164500476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12959 PALMS WEST DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LOXAHATCHEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33470-4937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-795-3333
Provider Business Mailing Address Fax Number:
561-791-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12959 PALMS WEST DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LOXAHATCHEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33470-4937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-795-3333
Provider Business Practice Location Address Fax Number:
561-791-3002
Provider Enumeration Date:
11/02/2006

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: 208000000X , with the licence number:  0024052901 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: ARNP9269394 , 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: 010204011 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com