Provider Demographics
NPI:1083085898
Name:GRAVES, HOLLY DAWN (APRN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:DAWN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DAWN
Other - Last Name:WILT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:67 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-6699
Mailing Address - Country:US
Mailing Address - Phone:316-210-3842
Mailing Address - Fax:
Practice Address - Street 1:1394 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2208
Practice Address - Country:US
Practice Address - Phone:850-517-1920
Practice Address - Fax:850-517-1950
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily