Provider Demographics
NPI:1396376596
Name:SHOEMAKER, HOLLY ANN (MSN, APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:305 WHITFIELD BND
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:GA
Mailing Address - Zip Code:30295-3584
Mailing Address - Country:US
Mailing Address - Phone:770-584-9121
Mailing Address - Fax:
Practice Address - Street 1:747 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4830
Practice Address - Country:US
Practice Address - Phone:770-228-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA206832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty