Provider Demographics
NPI:1831264365
Name:HARGROVE, HOLLY M (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:PA-C
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 334
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0238
Mailing Address - Country:US
Mailing Address - Phone:609-509-6043
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 334
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-0238
Practice Address - Country:US
Practice Address - Phone:609-509-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051331363AM0700X
NJ25MP00146900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH1017892OtherDEA
MH1017892OtherDEA