Provider Demographics
NPI:1871775585
Name:HOLLINGER, JESSIE LYNN (PA)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:LYNN
Last Name:HOLLINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JESSIE
Other - Middle Name:LYNN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:9520 BONITA BEACH RD SE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4517
Practice Address - Country:US
Practice Address - Phone:239-319-2195
Practice Address - Fax:239-319-2194
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003672363A00000X
FLPA9109449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant