Provider Demographics
NPI:1649761461
Name:HOLLOWWA, CRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:HOLLOWWA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 PEBBLE BEACH DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5803
Mailing Address - Country:US
Mailing Address - Phone:301-467-2250
Mailing Address - Fax:
Practice Address - Street 1:5310 HOMESTEAD RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1524
Practice Address - Country:US
Practice Address - Phone:505-237-2574
Practice Address - Fax:505-237-3632
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2018-0026363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical