Provider Demographics
NPI:1891463576
Name:HOLLINGSWORTH, JENNIFER Y (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:Y
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BREMEN WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6950
Mailing Address - Country:US
Mailing Address - Phone:601-918-0008
Mailing Address - Fax:
Practice Address - Street 1:110 BREMEN WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6950
Practice Address - Country:US
Practice Address - Phone:601-918-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily