MEDICARE: JUANITA ANNELISE HOLT

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	363LF0000X	Family Nurse Practitioner	F04210631	FL

General Provider Information

NPI Number	:	1093389033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA ANNELISE HOLT

Provider Business Mailing Address
First Line	:	5300 EAST AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2387
Country	:	US
Telephone Number	:	561-236-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6874 ALISO AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1036
Country	:	US
Telephone Number	:	561-236-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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Directions to “ JUANITA ANNELISE HOLT ” Practice Location

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