Healthcare Provider Details

I. General information

NPI: 1679404230
Provider Name (Legal Business Name): BLENDED LOGISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 SE OLD COUNTY CAMP RD
MADISON FL
32340-7013
US

IV. Provider business mailing address

13475 ATLANTIC BLVD STE 8
JACKSONVILLE FL
32225-3290
US

V. Phone/Fax

Practice location:
  • Phone: 904-775-3015
  • Fax:
Mailing address:
  • Phone: 904-775-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: EBONY ROBINSON
Title or Position: CEO
Credential:
Phone: 904-775-3015