| Doctor Name: | AUDRIS BOL |
| NPI Number: | 1144603796 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | TRN 21709 |
| Business Practice Address: | 83 Columbia St Orlando, FL - 328061101 |
| Business Phone Number: | 3218433220 |
| Business Fax Number: | 3218433210 |
| Mailing Address: | 86 W Underwood St Ste 202, ORLANDO |
| State: | FL |
| Postal Code: | 328061110 |
| Phone Number: | 4076496876 |
| Fax Number: | 4078720544 |
| NPI Enumeration Date: | 07/01/2015 |
| NPI Last Update Date: | 07/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | TRN 21709 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |