Provider Demographics
NPI:1013104561
Name:BOISVERT, FRED A (RN)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:A
Last Name:BOISVERT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3707
Mailing Address - Country:US
Mailing Address - Phone:813-855-0068
Mailing Address - Fax:
Practice Address - Street 1:209 SHORE DR E
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3707
Practice Address - Country:US
Practice Address - Phone:813-855-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2729532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse