Provider Demographics
NPI:1740268101
Name:ARCHER, HOLLY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:ARCHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LYNN
Other - Last Name:HARGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:655 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3756
Practice Address - Country:US
Practice Address - Phone:770-536-6300
Practice Address - Fax:770-536-6006
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01313439OtherAMERIGROUP
GA621666278HMedicaid
GA621666278IMedicaid
GA5226059OtherWELLCARE
GAP00827394OtherMEDICARE RAILROAD
GAP00827394OtherMEDICARE RAILROAD
GA621666278IMedicaid