Healthcare Provider Details

I. General information

NPI: 1578885562
Provider Name (Legal Business Name): TERESE ANN HOLMQUIST ANP MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR SUITE 400
VAIL CO
81657-5242
US

IV. Provider business mailing address

181 W MEADOW DR SUITE 200
VAIL CO
81657-5242
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax: 970-479-5875
Mailing address:
  • Phone: 970-476-1100
  • Fax: 970-479-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number130180
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0003517
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0100291
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: