Provider Demographics
NPI:1629205760
Name:HOLLINGSWORTH, JACQUELINE REBECCA (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:REBECCA
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:REBECCA
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 SPEEN ST
Mailing Address - Street 2:#106
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1563
Mailing Address - Country:US
Mailing Address - Phone:719-310-8694
Mailing Address - Fax:
Practice Address - Street 1:85 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8200
Practice Address - Country:US
Practice Address - Phone:508-383-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272679367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty