Provider Demographics
NPI:1235850280
Name:HOLT, MICHELLE JEANETTE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANETTE
Last Name:HOLT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2998 CHAPIN PASS
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3890
Mailing Address - Country:US
Mailing Address - Phone:727-741-8130
Mailing Address - Fax:
Practice Address - Street 1:10494 NORTHCLIFFE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3656
Practice Address - Country:US
Practice Address - Phone:352-686-3991
Practice Address - Fax:352-666-0393
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9388714363LF0000X
FLAPRN11021839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily