MEDICARE: JACQUELINE BOULEY

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	367500000X	Certified Registered Nurse Anesthetist	11045110	FL

General Provider Information

NPI Number	:	1891663977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BOULEY

Provider Business Mailing Address
First Line	:	2436 N FEDERAL HWY # 324
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6854
Country	:	US
Telephone Number	:	339-224-1810
Fax Number	:

Provider Business Practice Location Address
First Line	:	9960 CENTRAL PARK BLVD N STE 400
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1705
Country	:	US
Telephone Number	:	561-295-9100
Fax Number	:

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

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	01/29/2026

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Directions to “ JACQUELINE BOULEY ” Practice Location

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