Provider Demographics
NPI:1194064642
Name:VANCE, HOLLY V (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:V
Last Name:VANCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 HOLSTON AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2166
Mailing Address - Country:US
Mailing Address - Phone:423-217-0919
Mailing Address - Fax:765-601-6651
Practice Address - Street 1:620 STATE ST STE 3010
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2260
Practice Address - Country:US
Practice Address - Phone:423-217-0919
Practice Address - Fax:765-601-6651
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN199974163W00000X
VA0001127433163W00000X
VA0024173751363LP0808X
VA0017143055363LP0808X
TN21531363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I7587Medicare PIN
VAVVL627B288Medicare PIN