Provider Demographics
NPI:1790049740
Name:HOLLENBECK, MARCIA E
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 PECAN CRSE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8708
Mailing Address - Country:US
Mailing Address - Phone:352-857-6631
Mailing Address - Fax:
Practice Address - Street 1:6311 PECAN CRSE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8708
Practice Address - Country:US
Practice Address - Phone:352-857-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL004151700385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child