Provider Demographics
NPI:1083040687
Name:HOLLAND, ERICKA WEAVER (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:WEAVER
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:MICHELLE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-556-0036
Practice Address - Fax:843-556-3871
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1976363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1725PAMedicaid
SCSC20209223Medicare UPIN