Provider Demographics
NPI:1326231762
Name:HOLLAND, SHAHLA TABASI (AP)
Entity Type:Individual
Prefix:MRS
First Name:SHAHLA
Middle Name:TABASI
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3403 NE US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-2813
Mailing Address - Country:US
Mailing Address - Phone:352-475-5772
Mailing Address - Fax:352-379-6171
Practice Address - Street 1:804 NW 16TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4012
Practice Address - Country:US
Practice Address - Phone:352-379-6171
Practice Address - Fax:352-246-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1163171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist