Provider Demographics
NPI:1831498849
Name:ANDERSON, HOLLY-ANNE NICKERSON (DMIN, MS, CRC)
Entity Type:Individual
Prefix:DR
First Name:HOLLY-ANNE
Middle Name:NICKERSON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMIN, MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 GREENON LANE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304
Mailing Address - Country:US
Mailing Address - Phone:850-585-5363
Mailing Address - Fax:
Practice Address - Street 1:2323 HANSEN COURT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-894-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00010408225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor