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General NPI Number Information
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NPI Number | 1407626153
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Entity Type | Individual
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Provider Name | HOLLY SANDBERG PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 3901 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7738
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Country | US
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Telephone | 814-969-1597
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 STATE HIGHWAY 114 APT 2309
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City | NORTHLAKE
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State | TX
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Zip | 76262-2267
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Country | US
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Telephone | 814-969-1597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17368
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License Number State | TX
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