Healthcare Provider Details

I. General information

NPI: 1619883816
Provider Name (Legal Business Name): JEFF HOLMAN RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

775 E ROBIN LN
FRESNO CA
93730-1261
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-220-6736
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-220-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number792081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: