Provider Demographics
NPI:1316090202
Name:HOLLAND, AMY REBECCA (RN, CPNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-374-1528
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1528
Practice Address - Fax:225-374-1611
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713158363LP0200X
LARN104466-AP04195363LP0200X
LAAP04195363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2152815Medicaid
LA1163244Medicaid
LA1450278Medicaid
LA1188522Medicaid
TXQ46650Medicare UPIN
LA3B847Medicare PIN
LA3B847CH71Medicare PIN