Provider Demographics
NPI:1881652527
Name:HOLMES, MARIANNE LEAL (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:LEAL
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0001
Mailing Address - Country:US
Mailing Address - Phone:843-844-8400
Mailing Address - Fax:
Practice Address - Street 1:719 OKATIE HWY # 170
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3963
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0455Medicaid
SCAPN 116OtherLICENSE
SCMH0302719OtherDEA NUMBER
SCNP0455Medicaid