Provider Demographics
NPI:1831316264
Name:BOLICK, COURTNEY NICOLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:BOLICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25368
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2368
Mailing Address - Country:US
Mailing Address - Phone:941-552-1189
Mailing Address - Fax:941-365-8635
Practice Address - Street 1:4621 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4920
Practice Address - Country:US
Practice Address - Phone:904-399-8884
Practice Address - Fax:909-399-8838
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9206412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily