MEDICARE: AMANDA LEE HOLLAND APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	215400	TN

General Provider Information

NPI Number	:	1417817735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEE HOLLAND APRN

Provider Business Mailing Address
First Line	:	130 INDEPENDENCE LN
Second Line	:
City	:	LA FOLLETTE
State	:	TN
Zip	:	37766-3073
Country	:	US
Telephone Number	:	423-562-1705
Fax Number	:

Provider Business Practice Location Address
First Line	:	759 ISLAND COVE RD
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5227
Country	:	US
Telephone Number	:	865-801-0461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	01/19/2026

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