Provider Demographics
NPI:1720593957
Name:MOONEY, HOLLI LYNN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:LYNN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 INDEPENDENT DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-4023
Mailing Address - Country:US
Mailing Address - Phone:850-394-4907
Mailing Address - Fax:850-394-4981
Practice Address - Street 1:4126 INDEPENDENT DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-4023
Practice Address - Country:US
Practice Address - Phone:850-394-4907
Practice Address - Fax:850-394-4981
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9308907363LP2300X
FLAPRN9308907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care