Healthcare Provider Details

I. General information

NPI: 1588262570
Provider Name (Legal Business Name): HOLLY JOYCE CARLSTRAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 09/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CARMEL CHASE CT
MANVEL TX
77578-3452
US

IV. Provider business mailing address

18 CARMEL CHASE CT
MANVEL TX
77578-3452
US

V. Phone/Fax

Practice location:
  • Phone: 281-740-4973
  • Fax:
Mailing address:
  • Phone: 281-740-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1016664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: