Healthcare Provider Details

I. General information

NPI: 1235850280
Provider Name (Legal Business Name): MICHELLE JEANETTE HOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10494 NORTHCLIFFE BLVD
SPRING HILL FL
34608-3656
US

IV. Provider business mailing address

2998 CHAPIN PASS
ODESSA FL
33556-3890
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-3991
  • Fax: 352-666-0393
Mailing address:
  • Phone: 727-741-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9388714
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: