Provider Demographics
NPI:1245339969
Name:NEVILLE, HOLLY LEIGH (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LEIGH
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 555
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-0072
Practice Address - Fax:954-981-0188
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME891872086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2689413-00Medicaid
FL2689413-00Medicaid
FLG78810Medicare UPIN