Healthcare Provider Details

I. General information

NPI: 1720915622
Provider Name (Legal Business Name): TATE BLANKESPOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

1922 210TH ST
INWOOD IA
51240-7734
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7606
  • Fax:
Mailing address:
  • Phone: 904-542-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: