Provider Demographics
NPI:1962290130
Name:HOLBROOK, JONATHAN (RN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8209
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-2058
Mailing Address - Country:US
Mailing Address - Phone:251-901-3011
Mailing Address - Fax:
Practice Address - Street 1:3499 BLAZER PKWY STE 330
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2828
Practice Address - Country:US
Practice Address - Phone:251-901-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1106819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse