Provider Demographics
NPI:1609804467
Name:HOLLAND, PAMELA DENESE (CRNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENESE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BYRON NELSON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1726
Mailing Address - Country:US
Mailing Address - Phone:602-793-3380
Mailing Address - Fax:
Practice Address - Street 1:11 BYRON NELSON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1726
Practice Address - Country:US
Practice Address - Phone:602-793-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240922367500000X
TXAP103210367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ144000&AZ480280OtherBLUE CROSS BLUE SHIELD
AZ750332OtherAHCCS #
AZ0480280OtherBLUE CROSS BLUE SHIELD
AZ0480280OtherBLUE CROSS BLUE SHIELD