Provider Demographics
NPI:1982224127
Name:HOLMQUIST, KRISTINA MAE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MAE
Last Name:HOLMQUIST
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 1:6551 HARRIS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6115
Mailing Address - Country:US
Mailing Address - Phone:817-263-6116
Mailing Address - Fax:817-263-6117
Practice Address - Street 1:6551 HARRIS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6115
Practice Address - Country:US
Practice Address - Phone:817-263-6116
Practice Address - Fax:817-263-6117
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145534363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology