MEDICARE: CARLY MELISSA HOLMES ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP3365642	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457676207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY MELISSA HOLMES ARNP

Provider Business Mailing Address
First Line	:	924 LAKE LINDLEY DR N
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-4106
Country	:	US
Telephone Number	:	386-314-6772
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2815
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-586-1810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	03/17/2018

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