Provider Demographics
NPI:1427034909
Name:KORICA, HOLLY L (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:KORICA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KORICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2702 NORTH 3RD STREET
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:1537 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4771
Practice Address - Country:US
Practice Address - Phone:489-257-2700
Practice Address - Fax:480-257-2701
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0241363LX0001X
AZRN075083363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ753774Medicaid
AZP40036Medicare UPIN
AZ753774Medicaid
133735Medicare PIN