Provider Demographics
NPI:1326307950
Name:BOLANOS, SHEILA ROLANDA GAMBOA (NP-C, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA ROLANDA
Middle Name:GAMBOA
Last Name:BOLANOS
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11625 CUSTER ROAD
Mailing Address - Street 2:SUITE 110 #315
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8784
Mailing Address - Country:US
Mailing Address - Phone:972-366-5533
Mailing Address - Fax:888-859-0497
Practice Address - Street 1:7505 OSLER DR STE 204
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:443-519-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR255962363LF0000X
CA95016105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily