Provider Demographics
NPI:1366901027
Name:HOLLEY, ANDREA MOBLEY
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MOBLEY
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST STE 700
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1835
Mailing Address - Country:US
Mailing Address - Phone:251-341-2870
Mailing Address - Fax:855-737-5542
Practice Address - Street 1:11 N WATER ST FL 10
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-5010
Practice Address - Country:US
Practice Address - Phone:251-341-2870
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily