Provider Demographics
NPI:1467527358
Name:HOLLY, TANIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:M
Last Name:HOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6615
Mailing Address - Country:US
Mailing Address - Phone:786-385-6433
Mailing Address - Fax:
Practice Address - Street 1:UF, DEPARTMENT OF PSYCHIATRY 1600 SW ARCHER ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610
Practice Address - Country:US
Practice Address - Phone:352-265-3284
Practice Address - Fax:352-265-7983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN3597273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN3597OtherFORENSIC PSYCHIATRY FELLO