Provider Demographics
NPI:1578046694
Name:HOLLINGSWORTH, JOANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9942 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1864
Mailing Address - Country:US
Mailing Address - Phone:305-282-5220
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 820
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3658
Practice Address - Country:US
Practice Address - Phone:813-844-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant