Provider Demographics
NPI:1528820560
Name:TABOR, HOLLY JEAN (FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:TABOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4420 POWELL GROVE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-6350
Mailing Address - Country:US
Mailing Address - Phone:919-521-0566
Mailing Address - Fax:
Practice Address - Street 1:2006 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2316
Practice Address - Country:US
Practice Address - Phone:919-322-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019504207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology