Healthcare Provider Details

I. General information

NPI: 1558984369
Provider Name (Legal Business Name): BLESSING INYANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4427 EMERSON ST STE A
JACKSONVILLE FL
32207-4969
US

IV. Provider business mailing address

PO BOX 220
STOCKBRIDGE GA
30281-0220
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-1513
  • Fax:
Mailing address:
  • Phone: 470-449-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-10269
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME170134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: