Provider Demographics
NPI:1194096966
Name:BOLTON, SUZANNE (RN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2135
Mailing Address - Country:US
Mailing Address - Phone:941-371-4799
Mailing Address - Fax:941-379-0555
Practice Address - Street 1:1500 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2135
Practice Address - Country:US
Practice Address - Phone:941-371-4799
Practice Address - Fax:941-379-0555
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 1017112163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 1017112OtherRN