Individual
KELLEY D HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
340 NW COMMERCE DR, LAKE CITY, FL 32055-4709
(386) 719-9000
Mailing address
4240 LIRON AVE APT 103, FORT MYERS, FL 33916-7868
(302) 419-6173
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAT9114916
FL
Other
Enumeration date
09/12/2021
Last updated
04/11/2022
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