Provider Demographics
NPI:1194062471
Name:STUBBS, HOLLY CHRISTINA (CRNA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHRISTINA
Last Name:STUBBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 BUTLER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5437
Mailing Address - Country:US
Mailing Address - Phone:803-238-6913
Mailing Address - Fax:
Practice Address - Street 1:4741 S COCHISE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6974
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA217065367500000X
MO2019043112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered