Provider Demographics
NPI:1013238344
Name:BOLLI, NATHANIEL MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:MATTHEW
Last Name:BOLLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18167 US HIGHWAY 19 N STE 650
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6576
Mailing Address - Country:US
Mailing Address - Phone:727-437-3530
Mailing Address - Fax:727-498-1159
Practice Address - Street 1:18167 US HIGHWAY 19 N STE 650
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6576
Practice Address - Country:US
Practice Address - Phone:727-437-3530
Practice Address - Fax:727-498-1159
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118640207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology