Provider Demographics
NPI:1134203300
Name:SKINNER, HOLLY JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JEAN
Last Name:SKINNER
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 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1424
Mailing Address - Country:US
Mailing Address - Phone:407-303-8127
Mailing Address - Fax:407-303-8197
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 540
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1424
Practice Address - Country:US
Practice Address - Phone:407-303-8127
Practice Address - Fax:407-303-8197
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL9212084N0400X
FLOS109942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO042ZMedicare PIN