Provider Demographics
NPI:1821388232
Name:HOLDER, AMELIA
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:HOLDER
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 1:1705 WOODMARKER CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2760
Mailing Address - Country:US
Mailing Address - Phone:813-333-5515
Mailing Address - Fax:813-662-4331
Practice Address - Street 1:1705 WOODMARKER CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2760
Practice Address - Country:US
Practice Address - Phone:813-333-5515
Practice Address - Fax:813-662-4331
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator