Provider Demographics
NPI:1114260759
Name:HOLMQUIST, AMANDA J (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:HOLMQUIST
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:4915 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2969
Practice Address - Country:US
Practice Address - Phone:480-969-3096
Practice Address - Fax:480-969-0963
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35887207V00000X
AZ54543207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology