Provider Demographics
NPI:1669020764
Name:BOLDUC, ALICIA MASON (APRN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MASON
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2103
Mailing Address - Country:US
Mailing Address - Phone:941-928-8999
Mailing Address - Fax:
Practice Address - Street 1:1716 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2103
Practice Address - Country:US
Practice Address - Phone:941-928-8999
Practice Address - Fax:833-493-3608
Is Sole Proprietor?:No
Enumeration Date:2019-09-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003217363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner