MEDICARE: HOLLY ANN PENLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA66517	CA

General Provider Information

NPI Number	:	1073303632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ANN PENLEY

Provider Business Mailing Address
First Line	:	3425 N 1ST ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6821
Country	:	US
Telephone Number	:	559-608-6500
Fax Number	:	559-608-6582

Provider Business Practice Location Address
First Line	:	2832 E TAMARIND DR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-7090
Country	:	US
Telephone Number	:	559-908-5945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	03/12/2026

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Directions to “ HOLLY ANN PENLEY ” Practice Location

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