=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043527427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY MAE HOLMES ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2010
-----------------------------------------------------
Last Update Date | 08/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1423 S US HIGHWAY 1
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-466-6855
-----------------------------------------------------
Fax | 772-464-6983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1423 S US HIGHWAY 1
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-466-6855
-----------------------------------------------------
Fax | 772-464-6983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9227672
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------