Healthcare Provider Details

I. General information

NPI: 1962063552
Provider Name (Legal Business Name): YALANDA CATRICE HOLMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ALICIA RD
LAKELAND FL
33801-2104
US

IV. Provider business mailing address

930 ALICIA RD
LAKELAND FL
33801-2104
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-1950
  • Fax:
Mailing address:
  • Phone: 863-430-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9164066
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9164066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: