Provider Demographics
NPI:1811615297
Name:HOLAS, SHADELL CHRISTINE (MSN, ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:SHADELL
Middle Name:CHRISTINE
Last Name:HOLAS
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4147
Mailing Address - Country:US
Mailing Address - Phone:954-675-6596
Mailing Address - Fax:
Practice Address - Street 1:7229 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1004
Practice Address - Country:US
Practice Address - Phone:954-824-2616
Practice Address - Fax:754-667-4007
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11021570363LF0000X
FLAPRN11021570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPW764OtherMEDICARE