Provider Demographics
NPI:1144720327
Name:BOLDEN, KAREN LOUISE (CEO)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:501 116TH AVE N APT 281
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2730
Mailing Address - Country:US
Mailing Address - Phone:727-485-7529
Mailing Address - Fax:
Practice Address - Street 1:501 116TH AVE N APT 281
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2730
Practice Address - Country:US
Practice Address - Phone:727-485-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide