Provider Demographics
NPI:1215632252
Name:WOODY, HOLLY JEANINE (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEANINE
Last Name:WOODY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:JEANINE
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:800 PRUDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8211
Mailing Address - Country:US
Mailing Address - Phone:904-202-2000
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8211
Practice Address - Country:US
Practice Address - Phone:904-202-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9196196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse