Provider Demographics
NPI:1437046786
Name:HOLLIDAY, REGINA ANN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:HOLLIDAY
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 1:12504 MART CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5636
Mailing Address - Country:US
Mailing Address - Phone:202-674-4648
Mailing Address - Fax:301-249-4230
Practice Address - Street 1:12504 MART CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5636
Practice Address - Country:US
Practice Address - Phone:202-674-4648
Practice Address - Fax:301-249-4230
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X
MDH430734067679374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health