Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP128992 | TX |
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP128992 | TX |
NPI | 1093184780 |
---|---|
Provider Name | Nicole Bramlett Bolf |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76104-4144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 16/11/2021 |