Provider Demographics
NPI:1770827776
Name:BOLDUC, ANNMARIE GREEN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANNMARIE
Middle Name:GREEN
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 1:3322 PURPLE MARTIN DR UNIT 142
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6746
Mailing Address - Country:US
Mailing Address - Phone:860-655-3395
Mailing Address - Fax:
Practice Address - Street 1:1617 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1040
Practice Address - Country:US
Practice Address - Phone:941-613-2400
Practice Address - Fax:941-613-2401
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005213363L00000X, 363LA2200X
FL11015846363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health