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NPI Code Detail

MEDICARE: BOLD CITY INTEGRATIVE CARE

MEDICARE: BOLD CITY INTEGRATIVE CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1750039244
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOLD CITY INTEGRATIVE CARE
Provider Business Mailing Address
First Line : 710 OTIS RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32220-2942
Country : US
Telephone Number : 904-400-0120
Fax Number :
Provider Business Practice Location Address
First Line : 8110 BLANDING BLVD STE 6
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-5823
Country : US
Telephone Number : 904-274-0532
Fax Number :
Authorized Official
Title or Position : APRN
Name : KATELYN BRYANT
Credential : NP
Telephone Number : 904-400-0120
Provider Enumeration Date : 03/14/2022
Last Update Date : 03/14/2022

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Directions to “BOLD CITY INTEGRATIVE CARE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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