Provider Demographics
NPI:1902482722
Name:HOLT, THERESA (APRN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 WILLISTON PARK PT STE 1028
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2165
Mailing Address - Country:US
Mailing Address - Phone:407-333-2518
Mailing Address - Fax:
Practice Address - Street 1:934 WILLISTON PARK PT STE 1028
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2165
Practice Address - Country:US
Practice Address - Phone:407-333-2518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily