Provider Demographics
NPI:1194314047
Name:COONEY, HOLLY MARIA (PA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIA
Last Name:COONEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MARIA
Other - Last Name:OFFENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21772 S ELLSWORTH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7709
Mailing Address - Country:US
Mailing Address - Phone:480-512-3700
Mailing Address - Fax:
Practice Address - Street 1:21772 S ELLSWORTH LOOP RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7709
Practice Address - Country:US
Practice Address - Phone:480-512-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant