Provider Demographics
NPI:1134117922
Name:HOLLAND, ANDREW JOSEPH (PAC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 A ST
Mailing Address - Street 2:CLEAR AS
Mailing Address - City:CLEAR
Mailing Address - State:AK
Mailing Address - Zip Code:99704-5360
Mailing Address - Country:US
Mailing Address - Phone:907-585-6415
Mailing Address - Fax:907-585-6244
Practice Address - Street 1:200 A ST
Practice Address - Street 2:CLEAR AS
Practice Address - City:CLEAR
Practice Address - State:AK
Practice Address - Zip Code:99704-5360
Practice Address - Country:US
Practice Address - Phone:907-585-6415
Practice Address - Fax:907-585-6244
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPA223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH0340567OtherDEA
MH0340567OtherDEA
R14832Medicare UPIN