Provider Demographics
NPI:1568698264
Name:HOLLAND-ELLIS, SEQUIA ANNISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SEQUIA
Middle Name:ANNISE
Last Name:HOLLAND-ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SEQUIA
Other - Middle Name:ANNISE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-346-5016
Mailing Address - Fax:910-346-4561
Practice Address - Street 1:31 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-346-5016
Practice Address - Fax:910-346-4561
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-01410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine