Provider Demographics
NPI:1841585825
Name:BOLTON, TONYA AMBER (DO)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:AMBER
Last Name:BOLTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 TERRY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4707
Mailing Address - Country:US
Mailing Address - Phone:863-287-9186
Mailing Address - Fax:
Practice Address - Street 1:2112 TERRY LN
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4707
Practice Address - Country:US
Practice Address - Phone:863-287-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79237207P00000X
390200000X
FLOS11846207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program