Provider Demographics
NPI:1811002603
Name:HOLLOWAY, TINA P (PHD, CRNP)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:P
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PHD, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 TALLYHO DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-8646
Mailing Address - Country:US
Mailing Address - Phone:706-544-0456
Mailing Address - Fax:706-544-9665
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-2566
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084506363LF0000X
MSR894747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily