Provider Demographics
NPI:1538901749
Name:HOLLIS, MADISON NICOLE (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 IDLEBRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3036
Mailing Address - Country:US
Mailing Address - Phone:727-483-0910
Mailing Address - Fax:
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-547-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical