Provider Demographics
NPI:1598334195
Name:BOLINE, EMILIE ANNE (MSN, APRN, ACNPC-AG)
Entity Type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:ANNE
Last Name:BOLINE
Suffix:
Gender:F
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:ANNE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7711 OCONNOR DR APT 1202
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5557
Mailing Address - Country:US
Mailing Address - Phone:512-905-6676
Mailing Address - Fax:
Practice Address - Street 1:4681 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1526
Practice Address - Country:US
Practice Address - Phone:512-671-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046876363LA2100X
TX811609163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine