Provider Demographics
NPI:1609511831
Name:HOLLYWOOD, BRIANA RAEIANTE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:RAEIANTE
Last Name:HOLLYWOOD
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 1:412 JENNIE MARIE CIR
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-4002
Mailing Address - Country:US
Mailing Address - Phone:972-217-2180
Mailing Address - Fax:
Practice Address - Street 1:412 JENNIE MARIE CIR
Practice Address - Street 2:
Practice Address - City:FERRIS
Practice Address - State:TX
Practice Address - Zip Code:75125-4002
Practice Address - Country:US
Practice Address - Phone:972-217-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic