Provider Demographics
NPI:1801883871
Name:BOLTON, PAMELA KAY (APRN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:BOLTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:WOJCIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-5333
Mailing Address - Fax:239-343-5321
Practice Address - Street 1:22655 BAYSHORE RD STE 110
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2005
Practice Address - Country:US
Practice Address - Phone:941-235-4900
Practice Address - Fax:941-235-4901
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1592302364SX0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306970200Medicaid