Provider Demographics
NPI:1700518818
Name:INSPIRED FUNCTIONAL MEDICINE
Entity type:Organization
Organization Name:INSPIRED FUNCTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, NP-C
Authorized Official - Phone:352-613-0997
Mailing Address - Street 1:2349 N LECANTO HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-6102
Mailing Address - Country:US
Mailing Address - Phone:352-444-9868
Mailing Address - Fax:352-358-2996
Practice Address - Street 1:330 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4606
Practice Address - Country:US
Practice Address - Phone:352-444-9868
Practice Address - Fax:352-358-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care