Holly Noelle Anderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9109997 Issued in FL

Practice address

3627 University Blvd S
Suite 615
Jacksonville, FL 32216-4230

Phone

(904) 399-1623

Fax

(904) 399-1624

NPI assigned

Jan 23, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, OK2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385

  AL

  Medicare reassignment
• Millennium Medical Services, L.L.C.

  • Psychiatry Physician
  • Norman, OK
  • NPI 1245286285
  Medicare reassignment
• Ou Health Partners, Inc

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1528642642
  Medicare reassignment
• Ou Health Partners, Inc

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1447834460
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1770020232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S",
            "address_2": "STE 615",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322167401",
            "telephone_number": "843-655-6748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 UNIVERSITY BLVD S",
            "address_2": "SUITE 615",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164230",
            "telephone_number": "904-399-1623",
            "fax_number": "904-399-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "HOLLY",
        "middle_name": "NOELLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-23",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Ivan Anderson, PHARM.D
• Esther Anderson
• Frances Anderson
• Gail M. Anderson, PSYD ABPP
• Haley Elizabeth Anderson, PA-C, ATC
• Jennifer Noble Anderson, LCSW
• Jennifer Wannet Anderson
• Joette Eileen Anderson, A.R.N.P.
• John S Anderson, D.P.M.
• Karen Elizabeth Anderson, M.D.

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.