Healthcare Provider Details

I. General information

NPI: 1205532702
Provider Name (Legal Business Name): AMBER NICOLE MORELAND-HOLMES DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 BLACK MANGROVE LN
RIVERVIEW FL
33578-5603
US

IV. Provider business mailing address

10315 BLACK MANGROVE LN
RIVERVIEW FL
33578-5603
US

V. Phone/Fax

Practice location:
  • Phone: 757-810-3526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11024321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: