Provider Demographics
NPI:1942699764
Name:HOLBROOK, TINA M (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-691-8070
Mailing Address - Fax:270-691-8026
Practice Address - Street 1:3151 STATE ROUTE 54
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2115
Practice Address - Country:US
Practice Address - Phone:270-685-1260
Practice Address - Fax:270-685-1284
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009168363LF0000X
IN71005324A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201276510Medicaid
KY7100326780Medicaid
IN201276510Medicaid
KYK186900Medicare PIN