Provider Demographics
NPI:1265991871
Name:HOLT, JANE (APRN AGNP-C)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:APRN AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5165
Mailing Address - Country:US
Mailing Address - Phone:931-502-3750
Mailing Address - Fax:931-502-3755
Practice Address - Street 1:647 DUNLOP LN STE 101
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-502-3750
Practice Address - Fax:931-502-3755
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health