Provider Demographics
NPI:1386640985
Name:BOLTON, ALICE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BAHIA VISTA ST
Mailing Address - Street 2:STE 108
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2636
Mailing Address - Country:US
Mailing Address - Phone:941-954-1101
Mailing Address - Fax:941-953-2707
Practice Address - Street 1:2750 BAHIA VISTA ST
Practice Address - Street 2:STE 108
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2636
Practice Address - Country:US
Practice Address - Phone:941-954-1101
Practice Address - Fax:941-953-2707
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP478692363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health