Individual
MRS. ALICIA RENA BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
407 SE 24TH ST, FORT LAUDERDALE, FL 33316-3915
(954) 467-2140
Mailing address
407 SE 24TH ST, FORT LAUDERDALE, FL 33316-3915
(954) 467-2140
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103331
FL
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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