Individual provider · Type 1 NPI

Mariah Carly Holst, NP

Gerontology Nurse Practitioner · Suffolk, VA

NPI number 1407771058 Active

Practice location

2790 Godwin Blvd Ste 360
Suffolk, VA 23434-8153

Fax (757) 995-7095

Other practice locations

  • 709 Elderberry Ct, Chesapeake, VA 23320-9219 · (760) 333-6412

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner Primary 363LG0600X0024198442 (VA)
Adult Health Nurse Practitioner 363LA2200X0024198442 (VA)
Acute Care Nurse Practitioner 363LA2100X0024198442 (VA)

Gerontology Nurse Practitioner: Definition to come...

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About NPI 1407771058

Mariah Carly Holst, NP's National Provider Identifier is 1407771058, issued on Aug 12, 2026. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Suffolk, VA. The record was last updated on Sep 30, 2026.