Active NPI
Stephanie Dyane Hollis, MD
- Anesthesiology Physician
- Ponte Vedra Beach, FL
National Provider Identifier
1750499349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- ME90482
- Practice address
- 315 S Ocean Grande Dr
Unit 103
Ponte Vedra Beach, FL 32082-4599 - Phone
- (904) 315-8765
- Fax
- (904) 827-0485
- NPI assigned
- Aug 25, 2006
- Last updated
- Jul 21, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | ME90482 | FL | Primary |
Addresses
Primary practice location
315 S Ocean Grande Dr
Unit 103
Ponte Vedra Beach, FL 32082-4599
Mailing address
851 Trafalgar CT.
Suite 200E
Maitland, FL 32751
Phone (407) 667-0444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 269914100 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500595200000",
"number": "1750499349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 TRAFALGAR CT.",
"address_2": "SUITE 200E",
"city": "MAITLAND",
"state": "FL",
"postal_code": "32751",
"telephone_number": "407-667-0444",
"fax_number": "407-667-4338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 S OCEAN GRANDE DR",
"address_2": "UNIT 103",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320824599",
"telephone_number": "904-315-8765",
"fax_number": "904-827-0485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "STEPHANIE",
"middle_name": "DYANE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2017-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "FL",
"license": "ME90482",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "269914100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ponte Vedra Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.