Provider Demographics
NPI:1508152489
Name:JOHNSON, HOLLY ANN (LICENSED BY FLORIDA)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICENSED BY FLORIDA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:506 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-4141
Mailing Address - Country:US
Mailing Address - Phone:352-423-1799
Mailing Address - Fax:352-306-6841
Practice Address - Street 1:506 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4141
Practice Address - Country:US
Practice Address - Phone:352-423-1799
Practice Address - Fax:352-306-6841
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2643237700000X
FLAS5705237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050404Medicaid