MEDICARE: ELIZABETH KOLB BOLAND NP

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	363L00000X	Nurse Practitioner	F 790	SC

General Provider Information

NPI Number	:	1700862323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KOLB BOLAND NP

Provider Business Mailing Address
First Line	:	4500 8TH DIVISION RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-5700
Country	:	US
Telephone Number	:	803-751-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 8TH DIVISION RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-5700
Country	:	US
Telephone Number	:	803-240-3407
Fax Number	:

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/14/2025

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