Healthcare Provider Details

I. General information

NPI: 1437474376
Provider Name (Legal Business Name): ISAKE LOCKETT HOLLOWAY RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2010
Last Update Date: 06/21/2026
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 866-646-3553
  • Fax:
Mailing address:
  • Phone: 866-646-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771653
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009302
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95009302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: