Provider Demographics
NPI:1316401268
Name:HOLT, ANGELA M (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:HOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEYS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-2920
Mailing Address - Country:US
Mailing Address - Phone:856-535-7142
Mailing Address - Fax:
Practice Address - Street 1:1617 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2414
Practice Address - Country:US
Practice Address - Phone:717-236-4682
Practice Address - Fax:717-236-2423
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR00895000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00895000OtherNJ BON
PA1036439920001Medicaid