Provider Demographics
NPI:1881084382
Name:CABELL, HOLLY (FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CABELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 SE NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4862
Mailing Address - Country:US
Mailing Address - Phone:772-626-1830
Mailing Address - Fax:
Practice Address - Street 1:2100 NEBRASKA AVE STE 111
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4831
Practice Address - Country:US
Practice Address - Phone:772-465-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3211572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily