Healthcare Provider Details

I. General information

NPI: 1073459335
Provider Name (Legal Business Name): HOLLY HOPF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 5TH ST
JASPER IN
47546-2717
US

IV. Provider business mailing address

785 E 600N
JASPER IN
47546-9435
US

V. Phone/Fax

Practice location:
  • Phone: 812-309-1473
  • Fax:
Mailing address:
  • Phone: 812-309-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28203280A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: