Provider Demographics
NPI:1891954046
Name:HOLLIMAN, LINDA R
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:HOLLIMAN
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:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32602-0722
Mailing Address - Country:US
Mailing Address - Phone:352-339-6374
Mailing Address - Fax:352-224-5462
Practice Address - Street 1:14104 NW 140 STREET
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32616
Practice Address - Country:US
Practice Address - Phone:352-339-6374
Practice Address - Fax:352-224-5462
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities