Provider Demographics
NPI:1073303632
Name:PENLEY, HOLLY ANN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:PENLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 E TAMARIND DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-7090
Mailing Address - Country:US
Mailing Address - Phone:559-908-5945
Mailing Address - Fax:
Practice Address - Street 1:2832 E TAMARIND DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-7090
Practice Address - Country:US
Practice Address - Phone:559-908-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant