Healthcare Provider Details

I. General information

NPI: 1184241176
Provider Name (Legal Business Name): UREKA DONITRA BLOUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 09/11/2025
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 ERVIN ST
SAINT AUGUSTINE FL
32084-3075
US

IV. Provider business mailing address

883 ERVIN ST
SAINT AUGUSTINE FL
32084-3075
US

V. Phone/Fax

Practice location:
  • Phone: 904-295-2942
  • Fax:
Mailing address:
  • Phone: 904-295-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number209924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: