Provider Demographics
NPI:1841583754
Name:HOLLISTER, HONGXEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:HONGXEN
Middle Name:N
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HONGXEN
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6901 SIMMONS LOOP FL 4
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9498
Mailing Address - Country:US
Mailing Address - Phone:813-302-8388
Mailing Address - Fax:813-302-8453
Practice Address - Street 1:6901 SIMMONS LOOP
Practice Address - Street 2:4TH FLOOR
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9498
Practice Address - Country:US
Practice Address - Phone:813-302-8388
Practice Address - Fax:813-302-8453
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119890207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012209200Medicaid
FL14V1VOtherBLUE CROSS BLUE SHIELD
FLP01532176Medicare PIN
FLHV391YMedicare PIN
FL012209200Medicaid