Provider Demographics
NPI:1821764382
Name:HOLTZ, DANIEL GENE (DNAP, CRNA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GENE
Last Name:HOLTZ
Suffix:
Gender:M
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 W LONOKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7095
Mailing Address - Country:US
Mailing Address - Phone:479-287-7496
Mailing Address - Fax:
Practice Address - Street 1:3490 W LONOKE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7095
Practice Address - Country:US
Practice Address - Phone:479-287-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR100276163W00000X
AR220654367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse