Healthcare Provider Details

I. General information

NPI: 1780729012
Provider Name (Legal Business Name): TINA JOANN HOLLAND R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

5120 GOLDEN VALLEY TRL
CASTLE ROCK CO
80109-8644
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0797
  • Fax: 303-797-9342
Mailing address:
  • Phone: 303-814-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number122255
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: