Provider Demographics
NPI:1376537738
Name:HOLLADAY, CHERELL D (ARNP)
Entity Type:Individual
Prefix:
First Name:CHERELL
Middle Name:D
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 HARD SCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9423
Mailing Address - Country:US
Mailing Address - Phone:352-217-2354
Mailing Address - Fax:
Practice Address - Street 1:4310 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9423
Practice Address - Country:US
Practice Address - Phone:352-217-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN091202363L00000X
FLARNP 9194444363LA2200X
SC3649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY061VZMedicare ID - Type Unspecified
FLS71145Medicare UPIN
SCAA32619090Medicare PIN