Provider Demographics
NPI:1154929495
Name:HOLLAND, EDRIS Y (RN MSN FNP-C)
Entity type:Individual
Prefix:
First Name:EDRIS
Middle Name:Y
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:RN MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41405 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1912
Mailing Address - Country:US
Mailing Address - Phone:310-672-4581
Mailing Address - Fax:
Practice Address - Street 1:520 W PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4229
Practice Address - Country:US
Practice Address - Phone:661-947-3300
Practice Address - Fax:661-947-3322
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374283163W00000X, 163WC1500X
CA95017058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95017058OtherFNP-C LICENSE NUMBER