Provider Demographics
NPI:1942868989
Name:SHANNON, HOLLY JACOBSEN (PMHNP, IBCLC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JACOBSEN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PMHNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22563 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9685
Mailing Address - Country:US
Mailing Address - Phone:831-521-7106
Mailing Address - Fax:
Practice Address - Street 1:450 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4029
Practice Address - Country:US
Practice Address - Phone:831-755-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034882363LP0808X
CAL-23443163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant