Individual
HOLLY RENEE BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 MED TECH PKWY, SUITE 200, JOHNSON CITY, TN 37604-4007
(423) 232-6120
Mailing address
101 MED TECH PKWY STE 200, JOHNSON CITY, TN 37604-4001
(423) 232-6120
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7703
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512908
—
TN
01
—
4078380
BLUE CROSS/BLUE SHIELD
TN
01
—
P00102426
MEDICARE RAILROAD
TN
Enumeration date
06/20/2006
Last updated
01/12/2024
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