Provider Demographics
NPI:1992991632
Name:HOLLAND, ANN B (DPM)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:B
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LAKE LINK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1003
Mailing Address - Country:US
Mailing Address - Phone:863-439-4000
Mailing Address - Fax:863-439-2257
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4374
Practice Address - Country:US
Practice Address - Phone:863-439-4000
Practice Address - Fax:863-439-2257
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2449213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340224000Medicaid
FLU87345Medicare UPIN
FL4475990001Medicare NSC
FL65428XMedicare PIN
FL340224000Medicaid