Provider Demographics
NPI:1568704005
Name:HOLLIS SISA, KAREN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HOLLIS SISA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:HOLLIS SISA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3301 PLANTATION GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2469
Mailing Address - Country:US
Mailing Address - Phone:703-346-8774
Mailing Address - Fax:
Practice Address - Street 1:3301 PLANTATION GROVE LN
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2469
Practice Address - Country:US
Practice Address - Phone:703-346-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily