Provider Demographics
NPI:1659345767
Name:HOLCEK, NANCY ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:HOLCEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELAINE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:18780 INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3593
Practice Address - Country:US
Practice Address - Phone:903-567-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02220455OtherMEDICARE RAIL ROAD
TX201468002Medicaid
TX85N209Medicare PIN
S54580Medicare UPIN