Provider Demographics
NPI:1083773311
Name:DOLAN, DENNIS MATTHEW (CRNA, APRN, PMHNP-S)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MATTHEW
Last Name:DOLAN
Suffix:
Gender:M
Credentials:CRNA, APRN, PMHNP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4661
Mailing Address - Country:US
Mailing Address - Phone:502-517-6218
Mailing Address - Fax:
Practice Address - Street 1:2325 ULMERTON RD STE 27
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3373
Practice Address - Country:US
Practice Address - Phone:833-358-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9493678367500000X
KY3732A367500000X
FLAPRN9493678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered