Provider Demographics
NPI:1013262138
Name:OUILLETTE, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:OUILLETTE
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 1:2309 CRESTOVER LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6789
Mailing Address - Country:US
Mailing Address - Phone:352-345-4456
Mailing Address - Fax:352-835-7740
Practice Address - Street 1:2309 CRESTOVER LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6789
Practice Address - Country:US
Practice Address - Phone:352-345-4456
Practice Address - Fax:352-835-7740
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111847207VG0400X
TXQ7940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology