=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053299768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN-ELIZABETH HOLT PLATT APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 STORK WAY
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29678-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-800-0100
-----------------------------------------------------
Fax | 864-800-0101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 STRAWBERRY LN
-----------------------------------------------------
City | CLEMSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29631-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-650-6851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 30879
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------