Provider Demographics
NPI:1437347325
Name:HOLMES, DANIEL (LPN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6178
Mailing Address - Country:US
Mailing Address - Phone:407-221-0532
Mailing Address - Fax:
Practice Address - Street 1:237 FERNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2116
Practice Address - Country:US
Practice Address - Phone:407-831-2411
Practice Address - Fax:407-831-6760
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN51666442084P0800X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164581633Medicaid
FL1164581633Medicare PIN
FL1164581633Medicare NSC
FL1164581633Medicaid
FL1164581633Medicare UPIN