Provider Demographics
NPI:1447383732
Name:WOLFE, HOLLY LYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 BARRET DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5211
Mailing Address - Country:US
Mailing Address - Phone:214-417-7661
Mailing Address - Fax:972-671-6784
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5421
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD07564OtherMEDICARE RR PALMETTO
TX206411501Medicaid
TX206411502Medicaid
TXDQ5280OtherMEDICARE RR PALMETTO
TX8K5850Medicare PIN
TXDQ5280OtherMEDICARE RR PALMETTO
TX8F0614Medicare ID - Type Unspecified