Provider Demographics
NPI:1043527427
Name:HOLMES, TAMMY MAE (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MAE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5102
Mailing Address - Country:US
Mailing Address - Phone:772-466-6855
Mailing Address - Fax:772-464-6983
Practice Address - Street 1:1423 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5102
Practice Address - Country:US
Practice Address - Phone:772-466-6855
Practice Address - Fax:772-464-6983
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9227672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004455800Medicaid