Provider Demographics
NPI:1962656348
Name:HOLLIS, NILA ERICA (NP)
Entity Type:Individual
Prefix:
First Name:NILA
Middle Name:ERICA
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 STONECASTLE PASS SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7668
Mailing Address - Country:US
Mailing Address - Phone:917-902-2167
Mailing Address - Fax:404-349-8582
Practice Address - Street 1:385 STONECASTLE PASS SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7668
Practice Address - Country:US
Practice Address - Phone:917-902-2167
Practice Address - Fax:404-349-8582
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN196128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily