Healthcare Provider Details

I. General information

NPI: 1285569095
Provider Name (Legal Business Name): NATHANIEL ALEJANDRO HOLGUIN I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

9142 LESTER LN
SPRING HILL FL
34606-1839
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 352-345-5343
  • Fax: 855-832-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberH425621023700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: