Provider Demographics
NPI:1467899211
Name:TICE, HOLLY ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:TICE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:HOSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1 HOSPITAL DR BLDG 2600
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2150
Mailing Address - Country:US
Mailing Address - Phone:724-304-4950
Mailing Address - Fax:412-279-3416
Practice Address - Street 1:1 HOSPITAL DR BLDG 2600
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2150
Practice Address - Country:US
Practice Address - Phone:724-304-4950
Practice Address - Fax:412-279-3416
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP012800OtherLICENSE NUMBER
PASP012800Medicaid