MEDICARE: HURGO BLANCHARD

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
1	363LF0000X	Family Nurse Practitioner	F12240044	FL

General Provider Information

NPI Number	:	1952112849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HURGO BLANCHARD

Provider Business Mailing Address
First Line	:	150 NE 96TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NE 96TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2726
Country	:	US
Telephone Number	:	786-262-5059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/18/2025

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Directions to “ HURGO BLANCHARD ” Practice Location

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