Provider Demographics
NPI:1841290483
Name:HOLOKA, JO ANN M (MD)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:M
Last Name:HOLOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CANNONBALL LN
Mailing Address - Street 2:
Mailing Address - City:INLET BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-8580
Mailing Address - Country:US
Mailing Address - Phone:815-378-2755
Mailing Address - Fax:850-909-0168
Practice Address - Street 1:VETERANS HEALTH ADMINISTRATION
Practice Address - Street 2:140 RICHARD JACKSON BLVD
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-0000
Practice Address - Country:US
Practice Address - Phone:850-636-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-01-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-28
Provider Licenses
StateLicense IDTaxonomies
IL036-067834207VG0400X
FLME108088207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16373Medicare UPIN