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General NPI Number Information
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NPI Number | 1528820560
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Entity Type | Individual
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Provider Name | HOLLY JEAN TABOR FNP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2006 FAIRVIEW RD
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City | RALEIGH
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State | NC
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Zip | 27608-2316
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Country | US
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Telephone | 919-322-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 POWELL GROVE CT
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City | RALEIGH
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State | NC
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Zip | 27606-6350
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Country | US
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Telephone | 919-521-0566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 5019504
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5019504
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License Number State | NC
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