Provider Demographics
NPI:1275201154
Name:POMERANZ, HOLLY WANDA (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:WANDA
Last Name:POMERANZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 BURCHETTE RD UNIT 306
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1054
Mailing Address - Country:US
Mailing Address - Phone:561-758-7358
Mailing Address - Fax:
Practice Address - Street 1:5100 BURCHETTE RD UNIT 306
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1054
Practice Address - Country:US
Practice Address - Phone:561-758-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine