Provider Demographics
NPI:1740773407
Name:HOLDER, KATE-LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATE-LYNN
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATE-LYNN
Other - Middle Name:
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1565 SAXON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5823
Mailing Address - Country:US
Mailing Address - Phone:386-917-7395
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5823
Practice Address - Country:US
Practice Address - Phone:386-917-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant