Provider Demographics
NPI:1639781396
Name:HOLLIS, VICTORIA (DNP FNP-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N DELTA DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2686
Mailing Address - Country:US
Mailing Address - Phone:901-552-7337
Mailing Address - Fax:
Practice Address - Street 1:2201 HORIZAN RD STE 4
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2926
Practice Address - Country:US
Practice Address - Phone:870-732-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily