MEDICARE: TARYN L BOLLING D. O

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	207RI0200X	Infectious Disease Physician	16838	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	:	1619400439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARYN L BOLLING D. O

Provider Business Mailing Address
First Line	:	3000 OASIS GRAND BLVD APT 1705
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14192 METROPOLIS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4331
Country	:	US
Telephone Number	:	239-245-8223
Fax Number	:

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

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	02/02/2025

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