Healthcare Provider Details

I. General information

NPI: 1750211363
Provider Name (Legal Business Name): TINA KAY HOLLOWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23413 E 103RD ST S
BROKEN ARROW OK
74014-3732
US

IV. Provider business mailing address

23413 E 103RD ST S
BROKEN ARROW OK
74014-3732
US

V. Phone/Fax

Practice location:
  • Phone: 918-724-3588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0059133
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: