Provider Demographics
NPI:1720381494
Name:HOLMES, OSA JILL
Entity Type:Individual
Prefix:
First Name:OSA
Middle Name:JILL
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 1:909 SE MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3264
Mailing Address - Country:US
Mailing Address - Phone:772-214-0196
Mailing Address - Fax:
Practice Address - Street 1:1870 FOREST HILL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8901
Practice Address - Country:US
Practice Address - Phone:561-904-6514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical