Provider Demographics
NPI:1255086625
Name:BOLT, DAHLIA JEANETTA (FNP)
Entity type:Individual
Prefix:MS
First Name:DAHLIA
Middle Name:JEANETTA
Last Name:BOLT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 FOREST GRN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1715
Mailing Address - Country:US
Mailing Address - Phone:718-360-6842
Mailing Address - Fax:
Practice Address - Street 1:217 FOREST GRN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1715
Practice Address - Country:US
Practice Address - Phone:718-360-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily