Provider Demographics
NPI:1962478412
Name:HOLLAND, CAROL EDWARDS (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:EDWARDS
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5010
Mailing Address - Country:US
Mailing Address - Phone:575-627-4200
Mailing Address - Fax:575-627-4212
Practice Address - Street 1:400 MILITARY HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6407
Practice Address - Country:US
Practice Address - Phone:575-627-9500
Practice Address - Fax:575-627-9535
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00402363LF0000X
NMR23239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74-2823514OtherGROUP TAX ID
NM65000579Medicaid
NM800521089OtherGROUP MEDICARE
NM1932187044OtherGROUP NPI
NM74-2823514OtherGROUP TAX ID