=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306399670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN HOLLOWAY AGACNP-BC / FNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2016
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 VERNON RD STE A
-----------------------------------------------------
City | LAGRANGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30240-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-803-8799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 VERNON RD STE A
-----------------------------------------------------
City | LAGRANGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30240-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-803-8799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | RN 9232842
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9232842
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9232842
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN325179
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------