Healthcare Provider Details

I. General information

NPI: 1841676285
Provider Name (Legal Business Name): JENNIFER MARIE HOLLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HIGHWAY 60
SOCORRO NM
87801-3914
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-8370
  • Fax: 575-835-8376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: