Healthcare Provider Details

I. General information

NPI: 1619236908
Provider Name (Legal Business Name): JACQUELINE BOLMER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE JACOBS

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 STERLING RUN BLVD
MOUNT ORAB OH
45154-8350
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 615-425-4200
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax: 615-425-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13279-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: