Provider Demographics
NPI:1790858397
Name:HOLODNIAK, ROSE MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:HOLODNIAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4885
Mailing Address - Country:US
Mailing Address - Phone:813-681-5714
Mailing Address - Fax:813-689-9557
Practice Address - Street 1:1383 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4885
Practice Address - Country:US
Practice Address - Phone:813-681-5714
Practice Address - Fax:813-689-9557
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical