Provider Demographics
NPI:1811917974
Name:HOLLOWAY, JANICE KING (NP)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:KING
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:K
Other - Last Name:PEAVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:20 STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6615
Mailing Address - Country:US
Mailing Address - Phone:843-757-6376
Mailing Address - Fax:
Practice Address - Street 1:102 BREEZEWOOD CT
Practice Address - Street 2:
Practice Address - City:ELLOREE
Practice Address - State:SC
Practice Address - Zip Code:29047-8100
Practice Address - Country:US
Practice Address - Phone:843-384-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162211363LF0000X
SCF958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP05498Medicare UPIN
GA50BBGMJMedicare ID - Type Unspecified