Provider Demographics
NPI:1508611203
Name:HOLMES, ALEXIS ABIGAIL
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ABIGAIL
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-2601
Mailing Address - Country:US
Mailing Address - Phone:904-386-4752
Mailing Address - Fax:
Practice Address - Street 1:1763 E 27TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-2601
Practice Address - Country:US
Practice Address - Phone:904-386-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239990376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker