Provider Demographics
NPI:1871519769
Name:HOLLINGSWORTH, KATHRYN TAYLOR (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:TAYLOR
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 NORWOOD PLACE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-921-0576
Mailing Address - Fax:
Practice Address - Street 1:1400 S ORLANDO AVENUE
Practice Address - Street 2:STE 210
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-622-5008
Practice Address - Fax:407-622-5003
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3194832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5187WMedicare ID - Type Unspecified