Provider Demographics
NPI:1457021180
Name:HOLMES, JYLLIAN
Entity Type:Individual
Prefix:
First Name:JYLLIAN
Middle Name:
Last Name:HOLMES
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 1:9645 BAYMEADOWS RD APT 909
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7823
Mailing Address - Country:US
Mailing Address - Phone:315-272-8068
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTHPARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4209
Practice Address - Country:US
Practice Address - Phone:904-824-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist