Healthcare Provider Details

I. General information

NPI: 1154309342
Provider Name (Legal Business Name): TANA DIANE HOLLOWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 1ST AVE NW
HICKORY NC
28601-6122
US

IV. Provider business mailing address

113 MANOR CIRCLE
MOORESVILLE NC
28115
US

V. Phone/Fax

Practice location:
  • Phone: 828-695-5900
  • Fax: 828-695-4256
Mailing address:
  • Phone: 713-294-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205739
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: