Provider Demographics
NPI:1134604655
Name:HOLLAND, CORRIE ANN (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:ANN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3013
Mailing Address - Country:US
Mailing Address - Phone:570-421-3872
Mailing Address - Fax:570-424-6631
Practice Address - Street 1:235 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3013
Practice Address - Country:US
Practice Address - Phone:570-421-3872
Practice Address - Fax:570-424-6631
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019194363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care