Provider Demographics
NPI:1487324927
Name:BRITTANY BLALOCK APRN LLC
Entity type:Organization
Organization Name:BRITTANY BLALOCK APRN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-778-4838
Mailing Address - Street 1:700 MARSH COVE LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1694
Mailing Address - Country:US
Mailing Address - Phone:904-788-4835
Mailing Address - Fax:
Practice Address - Street 1:700 MARSH COVE LN
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1694
Practice Address - Country:US
Practice Address - Phone:904-788-4835
Practice Address - Fax:904-282-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty