Provider Demographics
NPI:1598080152
Name:HOLLIES, JAYDA MARIA
Entity Type:Individual
Prefix:MRS
First Name:JAYDA
Middle Name:MARIA
Last Name:HOLLIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 EAST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5105
Mailing Address - Country:US
Mailing Address - Phone:225-993-6709
Mailing Address - Fax:
Practice Address - Street 1:275 EAST DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5105
Practice Address - Country:US
Practice Address - Phone:225-993-6709
Practice Address - Fax:225-218-4446
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007926292343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)