Provider Demographics
NPI:1104306893
Name:HOLLEY, BRIDGET ROSA
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ROSA
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 1:210 W OAK ST # 170
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2710
Mailing Address - Country:US
Mailing Address - Phone:903-373-2923
Mailing Address - Fax:
Practice Address - Street 1:210 W OAK ST # 170
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2710
Practice Address - Country:US
Practice Address - Phone:903-373-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL668620163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse