Provider Demographics
NPI:1619255643
Name:HOLLAND, JESSICA ANZEVINO (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANZEVINO
Last Name:HOLLAND
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 1:1570 GROVE TER
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4033
Mailing Address - Country:US
Mailing Address - Phone:813-727-3264
Mailing Address - Fax:
Practice Address - Street 1:7335 W SAND LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5539
Practice Address - Country:US
Practice Address - Phone:407-352-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant