Provider Demographics
NPI:1245785708
Name:HOLLANDER, ELIZABETH ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:HOLLANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6919
Mailing Address - Country:US
Mailing Address - Phone:708-341-4009
Mailing Address - Fax:
Practice Address - Street 1:6832 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-9723
Practice Address - Country:US
Practice Address - Phone:910-859-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001006549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant