Provider Demographics
NPI:1477805521
Name:BROGAN, HOLLY L (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:BROGAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 VENTNOR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2222
Mailing Address - Country:US
Mailing Address - Phone:609-822-4242
Mailing Address - Fax:609-822-3211
Practice Address - Street 1:9701 VENTNOR AVE STE 201
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2222
Practice Address - Country:US
Practice Address - Phone:609-822-4242
Practice Address - Fax:609-822-3211
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00400700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered