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General NPI Number Information
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NPI Number | 1568432748
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Entity Type | Individual
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Provider Name | MARY ELIZABETH HOLTHAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 595 N COURTENAY PKWY STE 206
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4851
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Country | US
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Telephone | 321-735-6220
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Fax | 321-507-4638
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Provider Business Mailing Address
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Address Line | 4730 N HABANA AVE STE 204
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City | TAMPA
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State | FL
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Zip | 33614-7148
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Country | US
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Telephone | 813-549-2134
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Fax | 813-864-4436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 3644
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License Number State | FL
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