Provider Demographics
NPI:1225008576
Name:SANDERS, HOLLI ANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:ANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4018
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4018
Mailing Address - Country:US
Mailing Address - Phone:662-377-4685
Mailing Address - Fax:662-377-2755
Practice Address - Street 1:4381 SOUTH EASON BLVD.
Practice Address - Street 2:SUITE 102B
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6586
Practice Address - Country:US
Practice Address - Phone:662-377-6610
Practice Address - Fax:662-377-6614
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR770552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02930813Medicaid
MS02930813Medicaid
MSP99093Medicare UPIN