Provider Demographics
NPI:1184967697
Name:HOLLINGSWORTH, STEPHANIE MCDEARMAN (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MCDEARMAN
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:5051 CARPENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2521
Practice Address - Country:US
Practice Address - Phone:850-416-7262
Practice Address - Fax:850-416-7246
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10488133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS329519YJ5DMedicare PIN