Healthcare Provider Details

I. General information

NPI: 1730747874
Provider Name (Legal Business Name): MRS. JODILYN GRACE HOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

IV. Provider business mailing address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

V. Phone/Fax

Practice location:
  • Phone: 850-341-4151
  • Fax:
Mailing address:
  • Phone: 850-254-4530
  • Fax: 850-366-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001285
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG00190110
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG00190110
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG00190110
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11001285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: