Provider Demographics
NPI:1528772555
Name:BOLANDER, JAYME NICOLE
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:NICOLE
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17473 ASHCOMB WAY
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6517
Mailing Address - Country:US
Mailing Address - Phone:813-291-4695
Mailing Address - Fax:
Practice Address - Street 1:10600 CHEVROLET WAY STE 10517473
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-4421
Practice Address - Country:US
Practice Address - Phone:813-291-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-309105163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE