Healthcare Provider Details

I. General information

NPI: 1083495964
Provider Name (Legal Business Name): CAITLIN SUZANNE HOLLAND NRP, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 KANAWHA RD
RIVERVIEW FL
33578-4943
US

IV. Provider business mailing address

8811 KANAWHA RD
RIVERVIEW FL
33578-4943
US

V. Phone/Fax

Practice location:
  • Phone: 702-769-2187
  • Fax:
Mailing address:
  • Phone: 702-769-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD543348
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA91180000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: