Provider Demographics
NPI:1952061616
Name:HOLT, MATTHEW ALLEN (FNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:HOLT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ASHBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2364
Mailing Address - Country:US
Mailing Address - Phone:609-312-1752
Mailing Address - Fax:
Practice Address - Street 1:34 ASHBURN AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2364
Practice Address - Country:US
Practice Address - Phone:609-312-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01249800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01249800OtherNJ BOARD OF NURSING