Provider Demographics
NPI:1679502595
Name:HOLT, CINDY A (CRNA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:HOLT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 FAIR RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1683
Mailing Address - Country:US
Mailing Address - Phone:912-486-1973
Mailing Address - Fax:912-681-4184
Practice Address - Street 1:1499 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-486-1973
Practice Address - Fax:912-681-4184
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179550367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11578314OtherCAQH PROVIDER ID
GA282383385BMedicaid