Healthcare Provider Details

I. General information

NPI: 1366255705
Provider Name (Legal Business Name): CHRISTINA MARIE HOLT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONG POND RD STE 212
PLYMOUTH MA
02360-2642
US

IV. Provider business mailing address

110 LONG POND RD STE 212
PLYMOUTH MA
02360-2642
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-0565
  • Fax:
Mailing address:
  • Phone: 508-746-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2361138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: