Provider Demographics
NPI:1205724762
Name:PAGE, HOLLY (AGNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 HUNTER RD LOT 10
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-0265
Mailing Address - Country:US
Mailing Address - Phone:863-801-1488
Mailing Address - Fax:
Practice Address - Street 1:2199 HUNTER RD LOT 10
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-0265
Practice Address - Country:US
Practice Address - Phone:863-801-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAG06250120363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG06250120OtherFLORIDA BOARD OF NURSING