Provider Demographics
NPI:1437674918
Name:SANDERS, HOLLY MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 JEFF DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6095
Mailing Address - Country:US
Mailing Address - Phone:731-431-1818
Mailing Address - Fax:
Practice Address - Street 1:176C W UNIVERSITY PKWY # C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1616
Practice Address - Country:US
Practice Address - Phone:731-660-6915
Practice Address - Fax:731-668-4557
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000022708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily