Healthcare Provider Details

I. General information

NPI: 1588588602
Provider Name (Legal Business Name): BOLD HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 PARENTAL HOME RD
JACKSONVILLE FL
32216-5702
US

IV. Provider business mailing address

7857 RITTENHOUSE LN
JACKSONVILLE FL
32256-3631
US

V. Phone/Fax

Practice location:
  • Phone: 904-881-4520
  • Fax:
Mailing address:
  • Phone: 904-881-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. YACOB HABBOUSH
Title or Position: OWNER
Credential: MD
Phone: 904-881-4520