Provider Demographics
NPI:1306399670
Name:HOLLOWAY, SEAN (AGACNP-BC / FNP-BC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:AGACNP-BC / FNP-BC
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1600 VERNON RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4143
Mailing Address - Country:US
Mailing Address - Phone:706-803-8799
Mailing Address - Fax:
Practice Address - Street 1:1600 VERNON RD STE A
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4143
Practice Address - Country:US
Practice Address - Phone:706-803-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9232842163WE0003X
FLARNP9232842363LA2100X
FLARNP 9232842363LF0000X
GARN325179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily