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NPI Code Detail

MEDICARE: MISS ELIZABETH ANN HOLLOWAY JENSEN DNP, FNP-BC,PMHNP-BC

MEDICARE: MISS ELIZABETH ANN HOLLOWAY JENSEN DNP, FNP-BC,PMHNP-BC
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
1363LF0000XFamily Nurse Practitioner4350SC
2363LP0808XPsychiatric/Mental Health Nurse Practitioner4350SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548230220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ELIZABETH ANN HOLLOWAY JENSEN DNP, FNP-BC,PMHNP-BC
Provider Business Mailing Address
First Line : 403 STONY LANDING RD
Second Line :
City : MONCKS CORNER
State : SC
Zip : 29461-3967
Country : US
Telephone Number : 843-761-8282
Fax Number : 843-761-7308
Provider Business Practice Location Address
First Line : 403 STONY LANDING RD
Second Line :
City : MONCKS CORNER
State : SC
Zip : 29461-3967
Country : US
Telephone Number : 843-761-8282
Fax Number : 843-761-7308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 10/13/2020

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29461-3967
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