Provider Demographics
NPI:1881852671
Name:HOLLOWAY, MINDY D (ACNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:D
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:ACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375
Mailing Address - Country:US
Mailing Address - Phone:931-598-1270
Mailing Address - Fax:833-642-0898
Practice Address - Street 1:604 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375
Practice Address - Country:US
Practice Address - Phone:931-598-1270
Practice Address - Fax:833-642-0898
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13534363LF0000X
TNAPN13534363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509754Medicaid