Provider Demographics
NPI:1659000917
Name:CACACE, HOLLIE E (CRNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:E
Last Name:CACACE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BRASS MILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1219
Mailing Address - Country:US
Mailing Address - Phone:443-252-8005
Mailing Address - Fax:
Practice Address - Street 1:615 W MACPHAIL RD STE 206
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4305
Practice Address - Country:US
Practice Address - Phone:443-643-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner