Provider Demographics
NPI:1164206348
Name:HOLMES, ALYSABETH VITITOE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSABETH
Middle Name:VITITOE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2836
Mailing Address - Country:US
Mailing Address - Phone:706-765-8809
Mailing Address - Fax:
Practice Address - Street 1:210 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2836
Practice Address - Country:US
Practice Address - Phone:706-765-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant