Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP1292862 | FL |
NPI | 1003275199 |
---|---|
Provider Name | Marykay Holt |
First Address | Spring Hill, FL 34609-8102 |
Second Address | New Port Richey, FL 34653-6219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 24/07/2017 |