Provider Demographics
NPI:1184508533
Name:BOLANOS, NILCIA DENISSE (NP)
Entity type:Individual
Prefix:
First Name:NILCIA
Middle Name:DENISSE
Last Name:BOLANOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NILCIA
Other - Middle Name:DENISSE
Other - Last Name:CASTELLANOS REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10203 LOCKWOOD PINES LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6327
Mailing Address - Country:US
Mailing Address - Phone:813-869-0099
Mailing Address - Fax:
Practice Address - Street 1:10203 LOCKWOOD PINES LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6327
Practice Address - Country:US
Practice Address - Phone:813-869-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUNLICENSED363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care