Provider Demographics
NPI:1134966195
Name:JORGENSEN, HOLLY LYNN (FNP, ARNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:FNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1119
Mailing Address - Country:US
Mailing Address - Phone:712-621-4333
Mailing Address - Fax:
Practice Address - Street 1:1 JACK FOSTER DR
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-4586
Practice Address - Country:US
Practice Address - Phone:712-246-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA180207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily