Provider Demographics
NPI:1700324423
Name:HOLMES, AMANDA JUNE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JUNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 EUCLID ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4092
Mailing Address - Country:US
Mailing Address - Phone:800-641-4651
Mailing Address - Fax:
Practice Address - Street 1:17150 EUCLID ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:800-641-4651
Practice Address - Fax:714-333-4838
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily