Provider Demographics
NPI:1649433723
Name:HOLT, CAROLYN ANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANNE
Last Name:HOLT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ANNE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:181 MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3060
Mailing Address - Country:US
Mailing Address - Phone:585-729-9367
Mailing Address - Fax:
Practice Address - Street 1:445 SAINT PAUL ST
Practice Address - Street 2:MEDICAL, HIGH FALLS BREWING CO
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1775
Practice Address - Country:US
Practice Address - Phone:585-263-9224
Practice Address - Fax:585-454-1878
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300056364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health