Healthcare Provider Details

I. General information

NPI: 1922429588
Provider Name (Legal Business Name): AMY HOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 10/29/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR STE 134
BRANDON FL
33511-0801
US

IV. Provider business mailing address

1463 OAKFIELD DR STE 134
BRANDON FL
33511-0801
US

V. Phone/Fax

Practice location:
  • Phone: 813-224-0525
  • Fax: 813-224-0622
Mailing address:
  • Phone: 813-224-0525
  • Fax: 813-224-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: