Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP1367 | AZ |
NPI | 1023048675 |
---|---|
Provider Name | Jill A Holland |
First Address | Phoenix, AZ 85027-4013 |
Second Address | Phoenix, AZ 85027-4013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
966541 | (05) | AZ |
S74100 | (02) |