Provider Demographics
NPI:1699568683
Name:JOHNSON, HOLLY ARD (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ARD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:ARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18919 HORSESHOE CIR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:AL
Mailing Address - Zip Code:36574-2909
Mailing Address - Country:US
Mailing Address - Phone:251-550-0585
Mailing Address - Fax:
Practice Address - Street 1:18919 HORSESHOE CIR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:AL
Practice Address - Zip Code:36574-2909
Practice Address - Country:US
Practice Address - Phone:251-550-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-183083163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse