Provider Demographics
NPI:1831316264
Name:BOLICK, COURTNEY NICOLE (ARNP)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:BOLICK
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:PO BOX 25368
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2368
Mailing Address - Country:US
Mailing Address - Phone:941-552-1189
Mailing Address - Fax:941-365-8635
Practice Address - Street 1:2820 NE 214TH ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1268
Practice Address - Country:US
Practice Address - Phone:855-444-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV823873363LF0000X, 363LP0808X
FL9206412363LP0808X
CA17236363LP0808X
FLARNP 9206412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health