Provider Demographics
NPI:1497749147
Name:OLIVEIRA, HOLLY (FNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:WELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-1358
Mailing Address - Country:US
Mailing Address - Phone:940-612-5562
Mailing Address - Fax:940-665-6201
Practice Address - Street 1:100 KIOWA DR W
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE KIOWA
Practice Address - State:TX
Practice Address - Zip Code:76240-9584
Practice Address - Country:US
Practice Address - Phone:940-612-5562
Practice Address - Fax:940-665-6201
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141099502Medicaid
TX141099502Medicaid
TX612407Medicare PIN