Provider Demographics
NPI:1346815875
Name:BOLERJACK, LUCY (DO)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:BOLERJACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:836 PRUDENTIAL DR STE 1202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8339
Practice Address - Country:US
Practice Address - Phone:904-493-5323
Practice Address - Fax:866-554-1605
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151014839207V00000X
FLOS22431207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology