Provider Demographics
NPI:1346693082
Name:HOLT, CYNTHIA SHANNON (PA-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SHANNON
Last Name:HOLT
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 1:1401 S BERETANIA ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-206-5301
Mailing Address - Fax:
Practice Address - Street 1:7656 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5941
Practice Address - Country:US
Practice Address - Phone:901-333-2525
Practice Address - Fax:901-786-6635
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant