Provider Demographics
NPI:1023500188
Name:HOLT, ANDRIA HOLMES (RN)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:HOLMES
Last Name:HOLT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:LYN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8916 S FLATIRON DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1704
Mailing Address - Country:US
Mailing Address - Phone:801-560-5480
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132
Practice Address - Country:US
Practice Address - Phone:801-581-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4924227-3102163WX0002X
UT4924227-4405363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4924227-3102OtherDOPL