Provider Demographics
NPI:1871895052
Name:HOLLAND, LINDA L
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
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 1:1241 WINTERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2263
Mailing Address - Country:US
Mailing Address - Phone:386-490-0084
Mailing Address - Fax:888-507-5747
Practice Address - Street 1:1241 WINTERVILLE ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2263
Practice Address - Country:US
Practice Address - Phone:386-383-0177
Practice Address - Fax:866-300-0779
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002160800171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002160800Medicaid