Active NPI
Angelica Latrice Bianca Holman
- Driver
- Des Plaines, IL
National Provider Identifier
1477465805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- MIGHTY1
- Practice address
- 9980 Holly LN
Des Plaines, IL 60016-1423 - Phone
- (984) 381-1603
- NPI assigned
- Sep 21, 2026
- Last updated
- Sep 21, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | MIGHTY1 | IL | Primary |
Addresses
Primary practice location
9980 Holly LN
Des Plaines, IL 60016-1423
Mailing address
9980 Holly LN
Des Plaines, IL 60016-1423
Phone (984) 381-1603
Other names 1
- Shombe Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1789948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789948800000",
"number": "1477465805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9980 HOLLY LN",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600161423",
"telephone_number": "984-381-1603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9980 HOLLY LN",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600161423",
"telephone_number": "984-381-1603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMAN",
"first_name": "ANGELICA",
"middle_name": "LATRICE BIANCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-09-21",
"last_updated": "2026-09-21",
"certification_date": "2026-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Driver",
"state": "IL",
"license": "MIGHTY1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHOMBE",
"last_name": "JACKSON",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Des Plaines, IL
- Carol G. Hoffenkamp, L.C.S.W.
- Carole Eileen Hoffman, MSW LCSW CSADC
- Elizabeth Hoffman, MSW
- Joshua Hoffstadter
- Holistic Homecare Provider
- Deborah E Holman, CRNA
- Holy Family Medical Center (Holy Family Anesthesia Group)
- Holy Family Medical Center - Des Plaines LLC
- Home Care Angels II, LLC
- Home Care Netwok LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.