Provider Demographics
NPI:1861633844
Name:MESSINA, HOLLY S (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:S
Last Name:MESSINA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 MAHONING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2366
Mailing Address - Country:US
Mailing Address - Phone:330-793-2701
Mailing Address - Fax:330-793-8688
Practice Address - Street 1:5533 MAHONING AVE FL 2
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2366
Practice Address - Country:US
Practice Address - Phone:330-793-2701
Practice Address - Fax:330-793-8688
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12305363LF0000X
PASP010246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057629Medicaid