Provider Demographics
NPI:1255978797
Name:HOLLOWAY, COURTNEY (FNP-C)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHITE HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3068
Mailing Address - Country:US
Mailing Address - Phone:423-335-0423
Mailing Address - Fax:
Practice Address - Street 1:399 9TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-4299
Practice Address - Fax:239-624-8856
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26662363L00000X
FLAPRN11038825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner