Individual
JACK HOLLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
HEBER VALLEY HOSPITAL, 1485 US-40, HEBER CITY, UT 84032
(435) 654-2500
Mailing address
6127 KINGSFORD AVE, PARK CITY, UT 84098-6317
(307) 203-7739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
161328
NC
367500000X
Certified Registered Nurse Anesthetist
053081
NC
367500000X
Certified Registered Nurse Anesthetist
821399
NV
367500000X
Certified Registered Nurse Anesthetist
Primary
9809402-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051521
—
NC
Enumeration date
01/19/2006
Last updated
10/26/2021
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