Provider Demographics
NPI:1023590858
Name:HOLLAR, LOUWANA L (NP-C)
Entity type:Individual
Prefix:
First Name:LOUWANA
Middle Name:L
Last Name:HOLLAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-3001
Mailing Address - Country:US
Mailing Address - Phone:850-582-4438
Mailing Address - Fax:
Practice Address - Street 1:127 OLD HIGHWAY 96
Practice Address - Street 2:SUITE A
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005
Practice Address - Country:US
Practice Address - Phone:478-922-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily