Provider Demographics
NPI:1568692960
Name:HOLLSTEN, RENITA KIMBERLY (ARNP)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:KIMBERLY
Last Name:HOLLSTEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9561 HOLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3141
Mailing Address - Country:US
Mailing Address - Phone:407-657-9962
Mailing Address - Fax:
Practice Address - Street 1:2718 N ORANGE AVE STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7611
Practice Address - Country:US
Practice Address - Phone:407-894-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1649012363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care