Provider Demographics
NPI:1417531757
Name:HOLLOWAY, JOY MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:MARIE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FLAJOLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9611
Mailing Address - Country:US
Mailing Address - Phone:989-598-0884
Mailing Address - Fax:
Practice Address - Street 1:930 FLAJOLE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-9611
Practice Address - Country:US
Practice Address - Phone:989-598-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily