Healthcare Provider Details

I. General information

NPI: 1770943235
Provider Name (Legal Business Name): VICTORIA HOLLINGSWORTH DAVIS APRN, PCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA ANNE HOLLINGSWORTH APRN, PPCNP

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2638 TWO NOTCH RD SUITE 110
COLUMBIA SC
29204-1454
US

IV. Provider business mailing address

PO BOX 5731
COLUMBIA SC
29250-5731
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-2500
  • Fax: 803-758-1726
Mailing address:
  • Phone: 803-256-2500
  • Fax: 803-758-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19701
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number19701
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number19701
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: