Provider Demographics
NPI:1629296355
Name:HOLLAND, NANCY W (PAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-240-5437
Mailing Address - Fax:252-240-3084
Practice Address - Street 1:3604 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-240-5437
Practice Address - Fax:252-240-3084
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical