Provider Demographics
NPI:1184158230
Name:BOULAY, CAROL ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:BOULAY
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 1:6198 52ND ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2405
Mailing Address - Country:US
Mailing Address - Phone:727-409-9211
Mailing Address - Fax:
Practice Address - Street 1:6198 52ND ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-2405
Practice Address - Country:US
Practice Address - Phone:727-409-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1756222363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology