Provider Demographics
NPI:1063735926
Name:BOLER, IVETTE ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:ELIZABETH
Last Name:BOLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:IVETTE
Other - Middle Name:BOLER
Other - Last Name:DONELAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1400
Mailing Address - Country:US
Mailing Address - Phone:727-821-0017
Mailing Address - Fax:727-502-8861
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-216-1141
Practice Address - Fax:727-796-1590
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1249762163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y03YYOtherBLUE CROSS / BLUE SHIELD
FL002116000Medicaid
FL002116000Medicaid
FLDD497ZMedicare PIN