Provider Demographics
NPI:1467844688
Name:GAMBLIN, HOLLY DILWORTH (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DILWORTH
Last Name:GAMBLIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ELYSE
Other - Last Name:DILWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:470 BRIGHAM TRL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6045
Mailing Address - Country:US
Mailing Address - Phone:706-498-1698
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-9900
Practice Address - Fax:706-721-7753
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered