Provider Demographics
NPI:1245524529
Name:HOLDER, MONIKA E (PA)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:E
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:5310 CLARK RD STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3229
Practice Address - Country:US
Practice Address - Phone:941-925-3627
Practice Address - Fax:866-405-4932
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2022-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105953363AM0700X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007794800Medicaid