Provider Demographics
NPI:1306399670
Name:HOLLOWAY, SEAN (AGACNP-BC / FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:AGACNP-BC / FNP-BC
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:13961 SW 278TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8518
Mailing Address - Country:US
Mailing Address - Phone:786-597-3507
Mailing Address - Fax:
Practice Address - Street 1:9555 SW 162ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6408
Practice Address - Country:US
Practice Address - Phone:786-467-2154
Practice Address - Fax:786-533-9703
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9232842163WE0003X
FLARNP9232842363LA2100X
FLARNP 9232842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care