Healthcare Provider Details

I. General information

NPI: 1790786739
Provider Name (Legal Business Name): ERICA BLAISDELL RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 LAKEPOINTE LN
PLANTATION FL
33322-5791
US

IV. Provider business mailing address

1181 LAKEPOINTE LN
PLANTATION FL
33322-5791
US

V. Phone/Fax

Practice location:
  • Phone: 754-246-5499
  • Fax: 954-753-5680
Mailing address:
  • Phone: 754-246-5499
  • Fax: 954-753-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRT5325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: