Individual
MR. JORGE MARIO BOLIVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
2801 NW 79TH AVE, DORAL, FL 33122-1174
(786) 466-1000
Mailing address
2801 NW 79TH AVE, DORAL, FL 33122-1174
(786) 466-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11016043
FL
363LA2100X
Acute Care Nurse Practitioner
Primary
11016043
FL
363LC0200X
Critical Care Medicine Nurse Practitioner
11016043
FL
Other
Enumeration date
10/18/2021
Last updated
03/25/2024
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