Provider Demographics
NPI:1114530706
Name:HOLLOWAY-VAUGHAN, RENEE DAWN (FNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:DAWN
Last Name:HOLLOWAY-VAUGHAN
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 1:1317 ANTIETAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6887
Mailing Address - Country:US
Mailing Address - Phone:706-570-9541
Mailing Address - Fax:
Practice Address - Street 1:1317 ANTIETAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6887
Practice Address - Country:US
Practice Address - Phone:706-570-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA142993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily