Provider Demographics
NPI:1053744391
Name:HOLDINESS, HEATHER BROOM (APRN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BROOM
Last Name:HOLDINESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8385
Mailing Address - Fax:850-969-2904
Practice Address - Street 1:903 DESOTO BLVD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-6100
Practice Address - Country:US
Practice Address - Phone:501-922-6266
Practice Address - Fax:501-922-8122
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004582363LA2100X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06336908Medicaid
AR212780758Medicaid
MS324141YJ5DMedicare PIN