Provider Demographics
NPI:1679733208
Name:HOLCOMB, LINDA S (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 FULMER RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-6911
Mailing Address - Country:US
Mailing Address - Phone:574-252-3085
Mailing Address - Fax:574-255-4342
Practice Address - Street 1:615 FULMER RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-6911
Practice Address - Country:US
Practice Address - Phone:574-252-3085
Practice Address - Fax:574-255-4342
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002673A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
236030OtherMEDICARE LEGACY
IN200332960Medicaid
INM40047569Medicare PIN