Provider Demographics
NPI:1184055600
Name:HOLLIMAN, TERRIN LEE (PA-C)
Entity type:Individual
Prefix:
First Name:TERRIN
Middle Name:LEE
Last Name:HOLLIMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERRIN
Other - Middle Name:LEE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4501 DIPLOMACY DR
Mailing Address - Street 2:ATTN: FINANCE/PROVIDER ENROLLMENT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5919
Mailing Address - Country:US
Mailing Address - Phone:907-729-4599
Mailing Address - Fax:
Practice Address - Street 1:26341 EKLUTNA VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5148
Practice Address - Country:US
Practice Address - Phone:907-688-6031
Practice Address - Fax:907-688-6032
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPADA1168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant