Provider Demographics
NPI:1851811616
Name:RACHEL HOLLENBACH, LLC
Entity Type:Organization
Organization Name:RACHEL HOLLENBACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-221-2535
Mailing Address - Street 1:4217 BAYMEADOWS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4676
Mailing Address - Country:US
Mailing Address - Phone:904-332-7431
Mailing Address - Fax:904-332-7408
Practice Address - Street 1:4217 BAYMEADOWS RD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4676
Practice Address - Country:US
Practice Address - Phone:904-332-7431
Practice Address - Fax:904-332-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3150732363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty