Provider Demographics
NPI:1669945259
Name:HOLMQUIST, CLAIRE ENGEL (PA)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ENGEL
Last Name:HOLMQUIST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 GOLF LINKS DR N STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8014
Mailing Address - Country:US
Mailing Address - Phone:704-321-3376
Mailing Address - Fax:
Practice Address - Street 1:11301 GOLF LINKS DR N STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8014
Practice Address - Country:US
Practice Address - Phone:704-321-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08705207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty