Provider Demographics
NPI:1710590773
Name:HOLLOMAN, RONNIE D
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:D
Last Name:HOLLOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 OLD WINTER GARDEN RD STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1374
Mailing Address - Country:US
Mailing Address - Phone:407-296-0995
Mailing Address - Fax:
Practice Address - Street 1:6302 OLD WINTER GARDEN RD STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1374
Practice Address - Country:US
Practice Address - Phone:404-766-6122
Practice Address - Fax:407-704-4953
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care