MEDICARE: MS. ESTELITA BOHOLST DALISAY APRN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN9209452	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366846297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ESTELITA BOHOLST DALISAY APRN-C

Provider Business Mailing Address
First Line	:	2995 DREW ST FL 2
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	863-294-4404
Fax Number	:	863-294-1059

Provider Business Practice Location Address
First Line	:	36245 US HWY 27 N
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-3744
Country	:	US
Telephone Number	:	863-421-9801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	08/02/2024

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