Provider Demographics
NPI:1770542698
Name:HOLLEY, JANINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 NEWBYS MILL TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7875
Mailing Address - Country:US
Mailing Address - Phone:804-674-1746
Mailing Address - Fax:
Practice Address - Street 1:7238 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3502
Practice Address - Country:US
Practice Address - Phone:804-559-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001893363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00703827OtherRR MEDICARE
VA018818F36Medicare PIN