Provider Demographics
NPI:1083094627
Name:HOLLIS, ELIZABETH ELLEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ELLEN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:186 CHATEAU DR.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:251-786-5472
Mailing Address - Fax:256-551-1902
Practice Address - Street 1:186 CHATEAU DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-4402
Practice Address - Fax:256-551-1902
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136600363L00000X
ALF0315163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner