Provider Demographics
NPI:1245991405
Name:HOLLAND, ANGELIC MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ANGELIC
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 JOSELSON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2036
Mailing Address - Country:US
Mailing Address - Phone:631-524-4339
Mailing Address - Fax:
Practice Address - Street 1:1061 JOSELSON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2036
Practice Address - Country:US
Practice Address - Phone:631-524-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339746164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse