Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | A004582 | AR |
Y | 363LA2200X | Nurse Practitioner - Adult Health | A004582 | AR |
N | 363LG0600X | Nurse Practitioner - Gerontology | A004582 | AR |
NPI | 1053744391 |
---|---|
Provider Name | Mrs. Heather Broom Holdiness |
First Address | Pensacola, FL 32514-6050 |
Second Address | Hot Springs Village, AR 71909-6100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2013 |
Last Update Date | 15/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06336908 | (05) | MS |
212780758 | (05) | AR |