MEDICARE: JESSICA HOLMES

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	2255A2300X	Athletic Trainer	25MT00227600	NJ

General Provider Information

NPI Number	:	1841749751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HOLMES

Provider Business Mailing Address
First Line	:	2641 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5943
Country	:	US
Telephone Number	:	201-761-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5943
Country	:	US
Telephone Number	:	201-761-7312
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	10/04/2016

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Directions to “ JESSICA HOLMES ” Practice Location

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