Provider Demographics
NPI:1912318254
Name:HOLTON, SQUIRLENA RENA (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:SQUIRLENA
Middle Name:RENA
Last Name:HOLTON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MRS
Other - First Name:LENA
Other - Middle Name:RENA
Other - Last Name:HOLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1725 E HIGHWAY 50
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5188
Mailing Address - Country:US
Mailing Address - Phone:352-243-6686
Mailing Address - Fax:
Practice Address - Street 1:1725 E HIGHWAY 50
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5188
Practice Address - Country:US
Practice Address - Phone:352-243-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9406964363LW0102X
IN71004990A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health