Healthcare Provider Details

I. General information

NPI: 1548360266
Provider Name (Legal Business Name): JOAN ANN HOLDSWORTH RN ANPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JOAN ANN CAMPBELL

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MIDDLEVILLE ROAD 118
NORTHPORT NY
11768
US

IV. Provider business mailing address

3365 BUNKER AVENUE
WANTAGH NY
11793
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax: 631-266-6040
Mailing address:
  • Phone: 516-221-0942
  • Fax: 631-266-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number302107
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: