Healthcare Provider Details

I. General information

NPI: 1588385124
Provider Name (Legal Business Name): TREVOR ALAN HOLLOWAY DNP, FNP-C, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S GILBERT RD STE 101
MESA AZ
85204-5235
US

IV. Provider business mailing address

1121 S GILBERT RD STE 101
MESA AZ
85204-5235
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5720
  • Fax:
Mailing address:
  • Phone: 480-827-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number264167
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number264167
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: