1578117867 NPI number — STACIE G HOLMES PROSTHESIS TRAINER

Table of content: STACIE G HOLMES PROSTHESIS TRAINER (NPI 1578117867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578117867 NPI number — STACIE G HOLMES PROSTHESIS TRAINER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLMES
Provider First Name:
STACIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PROSTHESIS TRAINER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578117867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 RENAISSANCE POINTE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-844-3205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W STATE ROAD 436 STE 2013
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-844-3205
Provider Business Practice Location Address Fax Number:
407-917-9688
Provider Enumeration Date:
07/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com