Healthcare Provider Details

I. General information

NPI: 1548230220
Provider Name (Legal Business Name): ELIZABETH ANN HOLLOWAY JENSEN DNP, FNP-BC,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

IV. Provider business mailing address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8282
  • Fax: 843-761-7308
Mailing address:
  • Phone: 843-761-8282
  • Fax: 843-761-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4350
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4350
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: