Provider Demographics
NPI:1528192408
Name:HOLT, FAITH ELLEN (LAC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ELLEN
Last Name:HOLT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 S OSCEOLA AVE
Mailing Address - Street 2:APT. B4
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5458
Mailing Address - Country:US
Mailing Address - Phone:407-405-1174
Mailing Address - Fax:
Practice Address - Street 1:415 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4554
Practice Address - Country:US
Practice Address - Phone:407-405-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist