Provider Demographics
NPI:1164075149
Name:HOLT, CHARDE (PA-CA)
Entity Type:Individual
Prefix:
First Name:CHARDE
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:PA-CA
Other - Prefix:
Other - First Name:CHARDE
Other - Middle Name:
Other - Last Name:BLOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839-1583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:671 WINYAH DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1226
Practice Address - Country:US
Practice Address - Phone:407-303-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant