Provider Demographics
NPI:1801197942
Name:DR. HOLLY WILLIAMS DO PA
Entity Type:Organization
Organization Name:DR. HOLLY WILLIAMS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-677-9174
Mailing Address - Street 1:7410 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4333
Mailing Address - Country:US
Mailing Address - Phone:813-677-1974
Mailing Address - Fax:813-677-2725
Practice Address - Street 1:7410 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4333
Practice Address - Country:US
Practice Address - Phone:813-677-1974
Practice Address - Fax:813-677-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054886300Medicaid
FL054886300Medicaid
FL80349Medicare PIN