Provider Demographics
NPI:1639175235
Name:HOLLY A SHEETS DPM PA
Entity Type:Organization
Organization Name:HOLLY A SHEETS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-326-3553
Mailing Address - Street 1:PO BOX 1962
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-1962
Mailing Address - Country:US
Mailing Address - Phone:386-326-3553
Mailing Address - Fax:386-326-3919
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:STE 510
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3867
Practice Address - Country:US
Practice Address - Phone:386-326-3553
Practice Address - Fax:386-326-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2661213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70430Medicare UPIN
65562BMedicare ID - Type Unspecified