Provider Demographics
NPI:1720175474
Name:HOLDEN, RITA M (CRNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 OLD CAMP RD STE 144
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5609
Mailing Address - Country:US
Mailing Address - Phone:352-753-2224
Mailing Address - Fax:352-753-0833
Practice Address - Street 1:910 OLD CAMP RD STE 144
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5609
Practice Address - Country:US
Practice Address - Phone:352-753-2224
Practice Address - Fax:352-753-0833
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007420363LA2200X
FLAPRN11010713363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP75250Medicare UPIN
PA202962K3HMedicare PIN