Provider Demographics
NPI:1447967278
Name:HOLLAND, SHELBY RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:RENEE
Other - Last Name:VARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5841 RECREATION DR APT 2125
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1026
Mailing Address - Country:US
Mailing Address - Phone:682-556-6782
Mailing Address - Fax:
Practice Address - Street 1:300 N RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4235
Practice Address - Country:US
Practice Address - Phone:817-431-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant