Healthcare Provider Details

I. General information

NPI: 1851263909
Provider Name (Legal Business Name): ANDRECIA COLETTE HOLMES LCSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 HIGH ST
PORTSMOUTH VA
23707-3236
US

IV. Provider business mailing address

4145 1ST ST
CHESAPEAKE VA
23324-1544
US

V. Phone/Fax

Practice location:
  • Phone: 757-398-2346
  • Fax:
Mailing address:
  • Phone: 757-675-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number0137000036
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136001087
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: