MEDICARE: HOLLY OLIVEIRA FNP

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
1	363LF0000X	Family Nurse Practitioner	564679	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497749147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY OLIVEIRA FNP

Provider Business Mailing Address
First Line	:	PO BOX 1358
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76241-1358
Country	:	US
Telephone Number	:	940-612-5562
Fax Number	:	940-665-6201

Provider Business Practice Location Address
First Line	:	100 KIOWA DR W
Second Line	:	SUITE 103
City	:	LAKE KIOWA
State	:	TX
Zip	:	76240-9584
Country	:	US
Telephone Number	:	940-612-5562
Fax Number	:	940-665-6201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	05/30/2024

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