Provider Demographics
NPI:1639416654
Name:HOLLAND, MEGAN RUTH (CRNA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RUTH
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RUTH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:906 W CANNON ST APT 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3052
Mailing Address - Country:US
Mailing Address - Phone:817-886-4976
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:906 W CANNON ST APT 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3052
Practice Address - Country:US
Practice Address - Phone:817-886-4976
Practice Address - Fax:972-233-3666
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751693367500000X
TXAP123109367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8806UGOtherBCBS TX
TX330338003Medicaid
TX8806UGOtherBCBS TX