Provider Demographics
NPI:1619156726
Name:DIDDEN, HOLLY GAYLE (AP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:GAYLE
Last Name:DIDDEN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3438
Mailing Address - Country:US
Mailing Address - Phone:813-964-8299
Mailing Address - Fax:813-932-8922
Practice Address - Street 1:4547 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6311
Practice Address - Country:US
Practice Address - Phone:813-963-0110
Practice Address - Fax:813-961-4777
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP952171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist