Provider Demographics
NPI:1477105377
Name:HOLLABAUGH, BRANDY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:HOLLABAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5275
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:70 MEDICAL CENTER CIR STE 310
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7850
Practice Address - Fax:540-245-7854
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477105377Medicaid