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NPI Code Detail

MEDICARE: DR. TOPAZ JERILYN HOLLOWAY AGPCNP

MEDICARE: DR. TOPAZ JERILYN HOLLOWAY AGPCNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner4704257322MI
2363LP2300XPrimary Care Nurse Practitioner4704257322MI
3363LA2200XAdult Health Nurse Practitioner4704257322MI

General Provider Information

NPI Number : 1194151993
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TOPAZ JERILYN HOLLOWAY AGPCNP
Provider Business Mailing Address
First Line : PO BOX 639295 DEPT 93394
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-9295
Country : US
Telephone Number : 248-266-4200
Fax Number : 855-618-6655
Provider Business Practice Location Address
First Line : 4154 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-2809
Country : US
Telephone Number : 810-687-1008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2013
Last Update Date : 12/06/2023

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