Healthcare Provider Details

I. General information

NPI: 1306779590
Provider Name (Legal Business Name): ANNA DE BOLT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 UINTA WAY APT 301
DENVER CO
80230-7329
US

IV. Provider business mailing address

82 UINTA WAY APT 301
DENVER CO
80230-7329
US

V. Phone/Fax

Practice location:
  • Phone: 808-256-7950
  • Fax:
Mailing address:
  • Phone: 808-256-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2755-P.A.
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2755-P.A.
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number24-537
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2755-P.A.
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTPPA1135
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberS.A.0003415
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: