Provider Demographics
NPI:1033408828
Name:HOLLOWAY, MARINA SUZANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:SUZANNE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3723
Mailing Address - Country:US
Mailing Address - Phone:731-507-0062
Mailing Address - Fax:
Practice Address - Street 1:230 E JAMES M CAMPBELL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-840-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15768208VP0000X, 363L00000X
TNAPN0000015768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner