Healthcare Provider Details

I. General information

NPI: 1093736498
Provider Name (Legal Business Name): MS. ANDREA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 ENTERPRISE RD SUITE 2
CLEARWATER FL
33763-1160
US

IV. Provider business mailing address

2555 ENTERPRISE RD SUITE 2
CLEARWATER FL
33763-1160
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-8288
  • Fax: 727-796-2712
Mailing address:
  • Phone: 727-365-8288
  • Fax: 727-796-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: