Provider Demographics
NPI:1861081796
Name:HOLLAND, STEPHANIE MICHELLE MILES (APRN-FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE MILES
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 GUAM DR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-4320
Mailing Address - Country:US
Mailing Address - Phone:252-414-7579
Mailing Address - Fax:
Practice Address - Street 1:501 E OJAI AVE
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2820
Practice Address - Country:US
Practice Address - Phone:252-414-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU20NP09363LF0000X
CANP95018110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily