Provider Demographics
NPI:1407354947
Name:AUGUSTUS, HOLLY M (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:608 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4342
Mailing Address - Country:US
Mailing Address - Phone:903-721-0865
Mailing Address - Fax:
Practice Address - Street 1:967 PRUITT PL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1153
Practice Address - Country:US
Practice Address - Phone:903-266-1599
Practice Address - Fax:903-266-1589
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily