Provider Demographics
NPI:1710242359
Name:HOLLAND, JACKLYN DENICE
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:DENICE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28198 PRETLOW RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-4105
Mailing Address - Country:US
Mailing Address - Phone:757-569-7813
Mailing Address - Fax:
Practice Address - Street 1:28198 PRETLOW RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-4105
Practice Address - Country:US
Practice Address - Phone:757-569-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide