Provider Demographics
NPI:1821734849
Name:BOLDENS INNOVATIVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:BOLDENS INNOVATIVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN/FNP-C
Authorized Official - Phone:804-616-1304
Mailing Address - Street 1:6437 OLD TOWNPOINT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3480
Mailing Address - Country:US
Mailing Address - Phone:804-616-1304
Mailing Address - Fax:
Practice Address - Street 1:6437 OLD TOWNPOINT RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3480
Practice Address - Country:US
Practice Address - Phone:804-616-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty