Provider Demographics
NPI:1982980314
Name:HOLLAND, SUZANNE LARA (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LARA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:DALBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:800 MARKET ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-2514
Mailing Address - Country:US
Mailing Address - Phone:314-474-0665
Mailing Address - Fax:
Practice Address - Street 1:530 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3315
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily