Provider Demographics
NPI:1083250260
Name:HOLLINGSWORTH, LISA DELORES
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DELORES
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 KINGFISH DR APT E
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5915
Mailing Address - Country:US
Mailing Address - Phone:443-226-3689
Mailing Address - Fax:
Practice Address - Street 1:5630 KINGFISH DR APT E
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5915
Practice Address - Country:US
Practice Address - Phone:443-226-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy