Healthcare Provider Details

I. General information

NPI: 1184056475
Provider Name (Legal Business Name): JENNIFER HOLLOWAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 KNOX ST STE. 200
TORRANCE CA
90502-1337
US

IV. Provider business mailing address

11209 RANNOCH LN
LOUISVILLE KY
40243-1253
US

V. Phone/Fax

Practice location:
  • Phone: 502-262-0266
  • Fax:
Mailing address:
  • Phone: 502-262-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1120533
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008227
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: