Provider Demographics
NPI:1922690676
Name:HOLMES, HEATHER JOI
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOI
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 NW 30TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1805
Mailing Address - Country:US
Mailing Address - Phone:954-997-0661
Mailing Address - Fax:
Practice Address - Street 1:4441 NW 30TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1805
Practice Address - Country:US
Practice Address - Phone:954-997-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty