Provider Demographics
NPI:1740239961
Name:ENDERS, HOLLY MICHAUX (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MICHAUX
Last Name:ENDERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 12TH. ST. STE. 203
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040
Mailing Address - Country:US
Mailing Address - Phone:305-293-5015
Mailing Address - Fax:305-293-5016
Practice Address - Street 1:1111 12TH. STREET
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-293-5015
Practice Address - Fax:305-293-5016
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9476466363L00000X, 363LP2300X
VA0024174157363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699858500Medicaid
MD613336-01OtherBLUE CROSS/BLUE SHIELD
MDS085E042Medicare PIN
MD613336-01OtherBLUE CROSS/BLUE SHIELD
MD699858500Medicaid