Provider Demographics
NPI:1144880329
Name:STAPLES, HOLLY COLLEEN (FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:COLLEEN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 WHITMAN WAY APT 211
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4658
Mailing Address - Country:US
Mailing Address - Phone:858-280-1899
Mailing Address - Fax:
Practice Address - Street 1:2210 ENCINITAS BLVD STE N
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4376
Practice Address - Country:US
Practice Address - Phone:858-280-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily