Boldens Innovative Healthcare LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

BOLDENS INNOVATIVE HEALTHCARE LLC

Practice address

6437 Old Townpoint Rd
Suffolk, VA 23435-3480

Phone

(804) 616-1304

NPI assigned

May 11, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jacqueline Lorraine Griffin, APRN/FNP-C

Title

Director/Ceo

Phone

(804) 616-1304

Specialties & licenses 1

Addresses

Other names 1

• Bold N Gams Health Wellness Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1821734849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6437 OLD TOWNPOINT RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353480",
            "telephone_number": "804-616-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6437 OLD TOWNPOINT RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353480",
            "telephone_number": "804-616-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLDENS INNOVATIVE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "DIRECTOR/CEO",
        "authorized_official_telephone_number": "804-616-1304",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN/FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bold N Gams Health Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Suffolk, VA
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.