Provider Demographics
NPI:1467902718
Name:HOLDEN, ANTHONY JAMES (CDL)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:CDL
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1124 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6232
Mailing Address - Country:US
Mailing Address - Phone:386-792-2483
Mailing Address - Fax:386-792-2483
Practice Address - Street 1:1124 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052
Practice Address - Country:US
Practice Address - Phone:386-792-2483
Practice Address - Fax:386-792-2483
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS530010630160347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle