Provider Demographics
NPI:1760950331
Name:MADDOX, HOLLY ANN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:600 GRESHAM DR FL 7
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3447
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHAM DR FL 7
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176838363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care