Provider Demographics
NPI:1528247244
Name:HOLLER, TERESA A (PA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HOLLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4000 SHIPYARD BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6194
Mailing Address - Country:US
Mailing Address - Phone:910-473-3222
Mailing Address - Fax:910-769-0063
Practice Address - Street 1:4000 SHIPYARD BLVD STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6194
Practice Address - Country:US
Practice Address - Phone:910-473-3222
Practice Address - Fax:910-769-0063
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical