Active NPI
Sally Jo Holloway
- Adult Companion
- Merritt Island, FL
National Provider Identifier
1477536050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 2070 Temple Ave
Merritt Island, FL 32953-4221 - Phone
- (321) 453-8976
- Fax
- (321) 453-8976
- NPI assigned
- Nov 28, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary | ||
| Day Training/Habilitation Specialist | 373H00000X |
Addresses
Primary practice location
2070 Temple Ave
Merritt Island, FL 32953-4221
Mailing address
2070 Temple Ave
Merritt Island, FL 32953-4221
Phone (321) 453-8976
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 676830098 | Medicaid | FL | |
| 676830096 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301443200000",
"number": "1477536050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2070 TEMPLE AVE",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329534221",
"telephone_number": "321-453-8976",
"fax_number": "321-453-8976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2070 TEMPLE AVE",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329534221",
"telephone_number": "321-453-8976",
"fax_number": "321-453-8976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "SALLY",
"middle_name": "JO",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-28",
"last_updated": "2011-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
},
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "676830098",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "676830096",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merritt Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.