Provider Demographics
NPI:1740830157
Name:BOLAND, TRISHA (APN-C)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BOLAND
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CENTER ST UNIT B2
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2653
Mailing Address - Country:US
Mailing Address - Phone:201-522-0972
Mailing Address - Fax:
Practice Address - Street 1:133 CENTER ST UNIT B2
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2653
Practice Address - Country:US
Practice Address - Phone:201-522-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00957800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology