Provider Demographics
NPI:1164206348
Name:HOLMES, ALYSABETH VITITOE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSABETH
Middle Name:VITITOE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:120 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-2521
Practice Address - Country:US
Practice Address - Phone:850-804-3600
Practice Address - Fax:850-804-3601
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2025-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9118173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant