Healthcare Provider Details

I. General information

NPI: 1164761821
Provider Name (Legal Business Name): KATHERINE HOLMES AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD SUITE 710
JACKSONVILLE FL
32223-8628
US

IV. Provider business mailing address

12276 SAN JOSE BLVD SUITE 710
JACKSONVILLE FL
32223-8628
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-5550
  • Fax:
Mailing address:
  • Phone: 904-262-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: