Provider Demographics
NPI:1770834517
Name:CARVAJAL, HOLLI LEANN (APRN)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:LEANN
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:LEANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:6420 W NEWBERRY RD
Practice Address - Street 2:EAST WING, SUITE 100
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4308
Practice Address - Country:US
Practice Address - Phone:352-332-3900
Practice Address - Fax:352-332-5009
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily