Provider Demographics
NPI:1457890428
Name:HOLLINGSWORTH, JAIMA (CNA)
Entity Type:Individual
Prefix:
First Name:JAIMA
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 OLD MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:BUNCOMBE
Mailing Address - State:IL
Mailing Address - Zip Code:62912-3318
Mailing Address - Country:US
Mailing Address - Phone:618-579-6980
Mailing Address - Fax:
Practice Address - Street 1:481 OLD MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:BUNCOMBE
Practice Address - State:IL
Practice Address - Zip Code:62912-3318
Practice Address - Country:US
Practice Address - Phone:618-579-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide