Provider Demographics
NPI:1235198540
Name:HOLMES, MONIQUE NICHOL (DPM)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICHOL
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-0499
Mailing Address - Country:US
Mailing Address - Phone:941-708-7669
Mailing Address - Fax:941-708-8893
Practice Address - Street 1:5600 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9352
Practice Address - Country:US
Practice Address - Phone:941-708-7669
Practice Address - Fax:941-708-8893
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL195594OtherAMERIGROUP
FL229615OtherAMERIGROUP DME
FL65827OtherBCBS
FL2453233OtherUNITED HEALTHCARE
FL340433100Medicaid
FL298508OtherWELLCARE
FL02060OtherUNIVERSAL
FL343481OtherWELLCARE DME
FLP103593OtherFREEDOM HEALTH
FL65827OtherBCBS
FL65827OtherBCBS