Provider Demographics
NPI:1386339596
Name:EDWARDS, HOLLIE LYNN
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:LYNN
Last Name:EDWARDS
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 1:6343 DREW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8591
Mailing Address - Country:US
Mailing Address - Phone:352-737-4167
Mailing Address - Fax:
Practice Address - Street 1:6343 DREW ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-8591
Practice Address - Country:US
Practice Address - Phone:352-737-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician