Provider Demographics
NPI:1043601842
Name:HOLSETH, SAUNDRA (DO)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:HOLSETH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 CYPRESS GARDENS BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2241
Mailing Address - Country:US
Mailing Address - Phone:863-401-4401
Mailing Address - Fax:866-824-2717
Practice Address - Street 1:5535 CYPRESS GARDENS BLVD STE 270
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-2241
Practice Address - Country:US
Practice Address - Phone:863-401-4401
Practice Address - Fax:866-824-2717
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14412207Q00000X, 207QS0010X
GA85870207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program