Provider Demographics
NPI:1497724801
Name:HOLLINGSWORTH, NATAKI A (MD)
Entity Type:Individual
Prefix:
First Name:NATAKI
Middle Name:A
Last Name:HOLLINGSWORTH
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 1:7600 LAKEVIEW PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4355
Mailing Address - Country:US
Mailing Address - Phone:972-412-8832
Mailing Address - Fax:972-412-2503
Practice Address - Street 1:7600 LAKEVIEW PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4355
Practice Address - Country:US
Practice Address - Phone:972-412-8832
Practice Address - Fax:972-412-2503
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142087901Medicaid
TX142087903Medicaid
TXH04212Medicare UPIN
TX8G4960Medicare ID - Type UnspecifiedDALLAS CTY MEDICARE
TX8J1184Medicare ID - Type Unspecified
TX8487K3Medicare ID - Type Unspecified
TX142087901Medicaid