Provider Demographics
NPI:1639546245
Name:HOLLIS, ANN HAMILTON (RN, PNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN HAMILTON
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-359-8855
Mailing Address - Fax:803-359-1257
Practice Address - Street 1:811 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2500
Practice Address - Country:US
Practice Address - Phone:803-359-8855
Practice Address - Fax:803-359-1257
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816893163W00000X
CA95002846363LP0200X
SC23488363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse