Provider Demographics
NPI:1154933463
Name:HOLESKO, AMANDA TAYLOR (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:TAYLOR
Last Name:HOLESKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PEARL RD STE B5
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3380
Mailing Address - Country:US
Mailing Address - Phone:844-307-5929
Mailing Address - Fax:
Practice Address - Street 1:7259 PEARL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4806
Practice Address - Country:US
Practice Address - Phone:440-243-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine