Provider Demographics
NPI:1184092488
Name:JOHNSON, HOLLI HINOTE (CRNP)
Entity type:Individual
Prefix:
First Name:HOLLI
Middle Name:HINOTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:
Other - Last Name:HINOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 241348
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1348
Mailing Address - Country:US
Mailing Address - Phone:334-288-7808
Mailing Address - Fax:334-387-3090
Practice Address - Street 1:660 MCQUEEN SMITH RD N
Practice Address - Street 2:STE E
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7554
Practice Address - Country:US
Practice Address - Phone:334-288-7808
Practice Address - Fax:334-387-3090
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-119421363LF0000X
FLOS7143363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology