Provider Demographics
NPI:1962571638
Name:HOLLADAY, GENARA N (AP, PHARM D, MD)
Entity type:Individual
Prefix:
First Name:GENARA
Middle Name:N
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:AP, PHARM D, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 OLD HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8803
Mailing Address - Country:US
Mailing Address - Phone:904-398-6400
Mailing Address - Fax:
Practice Address - Street 1:4741 ATLANTIC BLVD STE E2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1138
Practice Address - Country:US
Practice Address - Phone:904-398-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP866OtherSTATE LICENSE