Provider Demographics
NPI:1588202600
Name:HOLLAND, NICHOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 OCEAN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9315 OCEAN HWY STE B
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2339
Practice Address - Country:US
Practice Address - Phone:410-896-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily