Provider Demographics
NPI:1811931058
Name:HOLDSWORTH, NOEL E (DNH, PMHNP-BC, CTS)
Entity type:Individual
Prefix:MS
First Name:NOEL
Middle Name:E
Last Name:HOLDSWORTH
Suffix:
Gender:F
Credentials:DNH, PMHNP-BC, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 N LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3821
Mailing Address - Country:US
Mailing Address - Phone:706-768-5787
Mailing Address - Fax:
Practice Address - Street 1:310 BLACK BEAR RIDGE
Practice Address - Street 2:BLACK BEAR TREATMENT CENTER
Practice Address - City:SAUTEE NACOOCHEE
Practice Address - State:GA
Practice Address - Zip Code:30571
Practice Address - Country:US
Practice Address - Phone:706-200-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA184767363LP0808X
NC0050-03355363LP0808X
FLARNP2596452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2047507OtherCIGNA
NC2593468AMedicare PIN
NC2593468Medicare PIN