Provider Demographics
NPI:1760522403
Name:HAMILTON, HOLLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:1132 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-2920
Practice Address - Country:US
Practice Address - Phone:904-432-3061
Practice Address - Fax:904-432-3062
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95834207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278979500Medicaid
GA098422839DMedicaid
FL14846OtherBCBS
GA316517813AMedicaid
FL14846OtherBCBS
FLH57690Medicare UPIN
FLAI786ZMedicare PIN