Provider Demographics
NPI:1366762221
Name:ADAMS, HOLLY A (RD, LD/N, MPH)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RD, LD/N, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9831 DEL WEBB PKWY
Mailing Address - Street 2:UNIT 4205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5800
Mailing Address - Country:US
Mailing Address - Phone:904-608-2126
Mailing Address - Fax:866-611-9445
Practice Address - Street 1:9831 DEL WEBB PKWY
Practice Address - Street 2:UNIT 4205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5800
Practice Address - Country:US
Practice Address - Phone:904-608-2126
Practice Address - Fax:866-611-9445
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3314133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND 3314OtherLICENSE NUMBER