Healthcare Provider Details

I. General information

NPI: 1447856968
Provider Name (Legal Business Name): TARA LYNN BOLING APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

506 HUNTING BOW LN
DUNCAN SC
29334-8403
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7165
  • Fax:
Mailing address:
  • Phone: 864-504-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPN.24394
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: