Provider Demographics
NPI:1992318489
Name:MIMS, HOLLIE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:MARIE
Last Name:MIMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WHISTLERS COVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-4329
Mailing Address - Country:US
Mailing Address - Phone:706-631-0046
Mailing Address - Fax:
Practice Address - Street 1:601 TEXAN TRL
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2547
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily