Basic Information
| Provider Information | |||||||||
| NPI: | 1851751630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLOWAY | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2686 W ALTON GLOOR BLVD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785204054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563502844 | ||||||||
| FaxNumber: | 9563500999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 W JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785206338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563502844 | ||||||||
| FaxNumber: | 9563500999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2016 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP130409 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | APRN.CNP.0030557 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.