Provider Demographics
NPI:1962853945
Name:ROTAN, HOLLY (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ROTAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 SW EGRET WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4231
Mailing Address - Country:US
Mailing Address - Phone:803-972-4280
Mailing Address - Fax:
Practice Address - Street 1:3500 SW CORPORATE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8156
Practice Address - Country:US
Practice Address - Phone:772-419-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390566363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care