Provider Demographics
NPI:1083919062
Name:HOLGUIN, GEOVANNA
Entity Type:Individual
Prefix:
First Name:GEOVANNA
Middle Name:
Last Name:HOLGUIN
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 1:1644 NW 143RD TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3002
Mailing Address - Country:US
Mailing Address - Phone:954-740-3253
Mailing Address - Fax:
Practice Address - Street 1:7971 RIVIERA BLVD STE 434
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6451
Practice Address - Country:US
Practice Address - Phone:305-984-2987
Practice Address - Fax:305-402-0125
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001528300Medicaid