Healthcare Provider Details

I. General information

NPI: 1063735926
Provider Name (Legal Business Name): IVETTE ELIZABETH BOLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVETTE BOLER DONELAN ARNP

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DR SUITE 309
SAFETY HARBOR FL
34695-6602
US

IV. Provider business mailing address

1201 5TH AVE N SUITE 505
ST PETERSBURG FL
33705-1400
US

V. Phone/Fax

Practice location:
  • Phone: 727-216-1141
  • Fax: 727-796-1590
Mailing address:
  • Phone: 727-821-0017
  • Fax: 727-502-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberARNP 1249762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: