1235892100 NPI number — DR. STEPHEN JAMES BOLING DNP/APRN MA PMHNP-BC

Table of content: DR. STEPHEN JAMES BOLING DNP/APRN MA PMHNP-BC (NPI 1235892100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235892100 NPI number — DR. STEPHEN JAMES BOLING DNP/APRN MA PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLING
Provider First Name:
STEPHEN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP/APRN MA PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235892100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13971 SW 146TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-7256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-419-2317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF FLORIDA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32611-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-419-2317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  11016052 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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