Provider Demographics
NPI:1306376694
Name:BOLTON, TRESSA A (CRNP)
Entity Type:Individual
Prefix:
First Name:TRESSA
Middle Name:A
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST STE 503
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1160
Mailing Address - Country:US
Mailing Address - Phone:334-240-2337
Mailing Address - Fax:334-293-8738
Practice Address - Street 1:1758 PARK PL STE 300
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1137
Practice Address - Country:US
Practice Address - Phone:334-293-8922
Practice Address - Fax:334-293-6820
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner