Provider Demographics
NPI:1093378283
Name:HOLBROOK, JLYNN (LVN)
Entity Type:Individual
Prefix:
First Name:JLYNN
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4430
Mailing Address - Country:US
Mailing Address - Phone:940-282-0491
Mailing Address - Fax:
Practice Address - Street 1:1369 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4430
Practice Address - Country:US
Practice Address - Phone:940-282-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177145164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse