Healthcare Provider Details

I. General information

NPI: 1487280285
Provider Name (Legal Business Name): ASHLEY NICOLE BLIZZARD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAGNOLIA AVE
AUBURNDALE FL
33823-4301
US

IV. Provider business mailing address

99 MAGNOLIA AVE
AUBURNDALE FL
33823-4301
US

V. Phone/Fax

Practice location:
  • Phone: 863-967-4451
  • Fax: 863-551-3542
Mailing address:
  • Phone: 863-967-4451
  • Fax: 863-551-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: