Provider Demographics
NPI:1023040300
Name:HOLSBEKE, MATTHEW J (ARNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:HOLSBEKE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:JULIUS
Other - Last Name:HOLSBEKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-7001
Practice Address - Fax:352-273-7388
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2154362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304887000Medicaid
FLE8466ZMedicare PIN
P72178Medicare UPIN
FL304887000Medicaid
FLE8466YMedicare PIN