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General NPI Number Information
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NPI Number | 1871033571
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Entity Type | Individual
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Provider Name | CAROLINE BOUCHER
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Gender | Female
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/22/2026
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Provider Practice Location Address
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Address Line | 200 GARDEN CITY PLZ STE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-3337
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Country | US
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Telephone | 407-757-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 200 GARDEN CITY PLZ STE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-3337
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Country | US
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Telephone | 407-757-5505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 714565
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9427482
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F353842-01
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License Number State | NY
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