Provider Demographics
NPI:1104041623
Name:HOLLAND, SARA J (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:CROOKSHANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6108 KILPATRICK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6108 KILPATRICK LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3197
Practice Address - Country:US
Practice Address - Phone:608-287-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005183363A00000X
OH50003326363AS0400X
WI4220-33363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8501058Medicaid
WA0220568OtherL&I
WAPA10005183OtherSTATE LICENSE
OH50.003326OtherOH LICENSE
WA8944261OtherL&I CV
WAPA10005183OtherSTATE LICENSE