Provider Demographics
NPI:1245952316
Name:BURKOT, HOLLY (CRNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BURKOT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3486 DOWNING CT
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21710-9420
Mailing Address - Country:US
Mailing Address - Phone:443-521-6379
Mailing Address - Fax:
Practice Address - Street 1:3486 DOWNING CT
Practice Address - Street 2:
Practice Address - City:ADAMSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21710-9420
Practice Address - Country:US
Practice Address - Phone:443-521-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily