Provider Demographics
NPI:1851489629
Name:HOLLOMAN, CARLA MONICA (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MONICA
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2530
Mailing Address - Country:US
Mailing Address - Phone:850-875-1146
Mailing Address - Fax:850-875-1218
Practice Address - Street 1:2140 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4314
Practice Address - Country:US
Practice Address - Phone:850-383-3428
Practice Address - Fax:850-383-3487
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL167177OtherHEALTHEASE- MEDICAID HMO
FL069578OtherVISTA HEALTHPLAN
FL255092000Medicaid
FL44300OtherBLUE CROSS BLUE SHIELD
FL069578OtherVISTA HEALTHPLAN
FLE1226YMedicare ID - Type Unspecified