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1396889127 NPI number — ETHEL HOLDER PA

NPI Number: 1396889127
Health Care Provider/Practitioner: ETHEL HOLDER PA

Information about “1396889127” NPI (ETHEL HOLDER PA) exists in 1396889127 in HTML format HTML  |  1396889127 in plain Text format TXT  |  1396889127 in PDF (Portable Document Format) PDF  |  1396889127 in an XML format XML  formats.

NPI Number : 1396889127 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396889127",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLDER",
    "FirstName": "ETHEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "425 W COLONIAL DR STE 303",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORLANDO",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32804-6863",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "407-382-1376",
    "MailingAddressFaxNumber": "833-450-5418",
    "FirstLinePracticeLocationAddress": "1130 S SEMORAN BLVD STE B-C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORLANDO",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32807-1457",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-382-1376",
    "PracticeLocationAddressFaxNumber": "833-450-5418",
    "EnumerationDate": "02/16/2007",
    "LastUpdateDate": "12/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA9109641",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "009214",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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