Provider Demographics
NPI:1548233166
Name:BOLTON, JOANNA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:GRACE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 E COUNTY ROAD 466
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3670
Mailing Address - Country:US
Mailing Address - Phone:352-399-7295
Mailing Address - Fax:352-399-7294
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-399-7295
Practice Address - Fax:352-399-7294
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128472207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology