Provider Demographics
NPI:1457618985
Name:BOLTON, JOANN EMMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:EMMANUEL
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:ROHINI
Other - Last Name:EMMANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0121
Mailing Address - Country:US
Mailing Address - Phone:904-215-2015
Mailing Address - Fax:
Practice Address - Street 1:2001 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5148
Practice Address - Country:US
Practice Address - Phone:904-215-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117202207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology