Healthcare Provider Details

I. General information

NPI: 1902482722
Provider Name (Legal Business Name): THERESA HOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA I HOLT APRN

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S ORANGE AVE
ORLANDO FL
32806-1226
US

IV. Provider business mailing address

PO BOX 23168
NEW YORK NY
10087-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax: 603-952-3900
Mailing address:
  • Phone: 941-444-0011
  • Fax: 603-952-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008523
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11008523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: