Provider Demographics
NPI:1649085218
Name:BOLES, WESLEY (RN BSN MBA)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:BOLES
Suffix:
Gender:M
Credentials:RN BSN MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BROOKS ST SE STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5840
Mailing Address - Country:US
Mailing Address - Phone:850-503-1060
Mailing Address - Fax:
Practice Address - Street 1:205 BROOKS ST SE STE 301
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5840
Practice Address - Country:US
Practice Address - Phone:850-503-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9298878163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator