Provider Demographics
NPI:1780870550
Name:HOLLINGSWORTH, TANDIS RENEE (OWN/ADMINISTRATOR)
Entity type:Individual
Prefix:MS
First Name:TANDIS
Middle Name:RENEE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:OWN/ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 LAKESIDE CIR APT 718
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5121
Mailing Address - Country:US
Mailing Address - Phone:972-316-8058
Mailing Address - Fax:972-316-2120
Practice Address - Street 1:805 LAKESIDE CIR APT 718
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5121
Practice Address - Country:US
Practice Address - Phone:972-316-8058
Practice Address - Fax:972-316-2120
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health