Provider Demographics
NPI:1649455163
Name:HOLLAND, JILL F (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:F
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 BAPTIST CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2629 BAPTIST CHAPEL RD
Practice Address - Street 2:
Practice Address - City:GODWIN
Practice Address - State:NC
Practice Address - Zip Code:28344-8605
Practice Address - Country:US
Practice Address - Phone:910-567-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000861Medicaid