Provider Demographics
NPI:1194001545
Name:HOLT, AMANDA MARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:HOLT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 PARK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8475
Mailing Address - Country:US
Mailing Address - Phone:704-351-0810
Mailing Address - Fax:704-790-2451
Practice Address - Street 1:10512 PARK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8475
Practice Address - Country:US
Practice Address - Phone:704-790-2450
Practice Address - Fax:704-790-2451
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC249245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily