Healthcare Provider Details

I. General information

NPI: 1609370378
Provider Name (Legal Business Name): ELIZABETH THERESA HOLLE MSN, RN, CCRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 02/04/2026
Reactivation Date: 05/19/2026

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213
US

IV. Provider business mailing address

430 CLEVELAND AVE
COLUMBUS OH
43215-2164
US

V. Phone/Fax

Practice location:
  • Phone: 614-546-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number022529
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number022529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: