Provider Demographics
NPI:1013796432
Name:VON HOLLEBEN, CHARLOTTE LOUISE (APRN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:VON HOLLEBEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1220 GREYBROOKE PL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5115
Mailing Address - Country:US
Mailing Address - Phone:727-412-4916
Mailing Address - Fax:727-785-2326
Practice Address - Street 1:3231 MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6607
Practice Address - Country:US
Practice Address - Phone:727-725-6863
Practice Address - Fax:727-725-6734
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11028799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner