Provider Demographics
NPI:1003315789
Name:COLLINS, HOLLY MARIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KISTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:7173 E SUPER 1 LOOP
Practice Address - Street 2:STE B
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801
Practice Address - Country:US
Practice Address - Phone:208-561-9901
Practice Address - Fax:208-561-9968
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID47201163W00000X
ID59037363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1003315789Medicaid