Healthcare Provider Details

I. General information

NPI: 1285902122
Provider Name (Legal Business Name): ELIZABETH ELAINE HOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 30TH AVE STE 201
ASTORIA NY
11103-4662
US

IV. Provider business mailing address

3811 DITMARS BLVD # 261
ASTORIA NY
11105-2176
US

V. Phone/Fax

Practice location:
  • Phone: 917-983-7390
  • Fax: 917-983-7393
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306310
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405112
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421112
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number004860
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: