Provider Demographics
NPI:1902381791
Name:HOLT, MONICA WILSON (FNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:WILSON
Last Name:HOLT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4400
Mailing Address - Country:US
Mailing Address - Phone:843-977-7337
Mailing Address - Fax:843-956-5415
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-4400
Practice Address - Country:US
Practice Address - Phone:843-977-7337
Practice Address - Fax:843-956-5415
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily