Healthcare Provider Details

I. General information

NPI: 1144872110
Provider Name (Legal Business Name): HOLLY CIARA MINGUS NOE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OVERSEAS HWY STE 38
MARATHON FL
33050-2744
US

IV. Provider business mailing address

2262 ORLANDO RD
BIG PINE KEY FL
33043-6318
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-7111
  • Fax: 305-743-7709
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number218423
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9326707
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: