Provider Demographics
NPI:1407288053
Name:HOLLIDAY, PATRICE MARLENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:MARLENE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:MARLENE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7611 25TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5236
Mailing Address - Country:US
Mailing Address - Phone:941-376-1944
Mailing Address - Fax:
Practice Address - Street 1:4401 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3142
Practice Address - Country:US
Practice Address - Phone:941-357-5550
Practice Address - Fax:941-792-7152
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN18610363LF0000X
FL9232802363LF0000X
MO2016035060363LF0000X
FLAPRN11013337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily