Provider Demographics
NPI:1447478458
Name:HOLDSTOCK, BRIAN JAMES (CFNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:HOLDSTOCK
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5578 N SHADY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-7420
Mailing Address - Country:US
Mailing Address - Phone:801-750-4012
Mailing Address - Fax:
Practice Address - Street 1:5136 N CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:801-254-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324854-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily