Provider Demographics
NPI:1861697310
Name:HOLLAND, TERESA ANN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349
Mailing Address - Country:US
Mailing Address - Phone:910-275-0195
Mailing Address - Fax:910-275-0192
Practice Address - Street 1:140 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-275-0195
Practice Address - Fax:910-275-0192
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593436Medicare PIN
1861697310Medicare PIN