Provider Demographics
NPI:1174084842
Name:HOLLINS, CHARLENE CHARISSE (FNP)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:CHARISSE
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715B WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3037
Mailing Address - Country:US
Mailing Address - Phone:978-222-0024
Mailing Address - Fax:617-582-2373
Practice Address - Street 1:715B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3037
Practice Address - Country:US
Practice Address - Phone:978-222-0024
Practice Address - Fax:617-582-2373
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261067363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner