Healthcare Provider Details

I. General information

NPI: 1588290456
Provider Name (Legal Business Name): ANDREA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 PLAZA DR STE 101
PARMA OH
44130-1043
US

IV. Provider business mailing address

12380 PLAZA DR STE 101
PARMA OH
44130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 216-898-8488
  • Fax: 216-362-0677
Mailing address:
  • Phone: 216-898-8488
  • Fax: 216-362-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026147
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: