Healthcare Provider Details

I. General information

NPI: 1508362328
Provider Name (Legal Business Name): JENYFEER BLANCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 N STATE ROAD 7
PARKLAND FL
33073-3504
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-315-5780
  • Fax: 354-346-4182
Mailing address:
  • Phone: 954-967-6400
  • Fax: 317-944-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME164955
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number01085977A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME164955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: