Provider Demographics
NPI:1982168514
Name:HOLLAND, JENNIFER M
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 BUD DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-4846
Mailing Address - Country:US
Mailing Address - Phone:850-398-3961
Mailing Address - Fax:
Practice Address - Street 1:2707 BUD DIAMOND RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-4846
Practice Address - Country:US
Practice Address - Phone:850-398-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty