MEDICARE: HOLISTIC HEALTHCARE PROVIDERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1063356822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTHCARE PROVIDERS LLC

Provider Business Mailing Address
First Line	:	600 N BROAD ST STE 5
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-1032
Country	:	US
Telephone Number	:	240-305-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	194 GLOUCESTER BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-8328
Country	:	US
Telephone Number	:	240-305-9501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN FANKMENI
Credential	:
Telephone Number	:	240-305-9501

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “HOLISTIC HEALTHCARE PROVIDERS LLC ” Practice Location

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