Healthcare Provider Details

I. General information

NPI: 1891663977
Provider Name (Legal Business Name): JACQUELINE BOULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CENTRAL PARK BLVD N STE 400
BOCA RATON FL
33428-1705
US

IV. Provider business mailing address

173 BELTRAN ST
MALDEN MA
02148-1227
US

V. Phone/Fax

Practice location:
  • Phone: 561-295-9100
  • Fax:
Mailing address:
  • Phone: 339-224-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: