Healthcare Provider Details

I. General information

NPI: 1194247221
Provider Name (Legal Business Name): MONICA MARIE BLEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11186 SPRING HILL DR
SPRING HILL FL
34609-4648
US

IV. Provider business mailing address

23988 US HIGHWAY 19 N
CLEARWATER FL
33765-1563
US

V. Phone/Fax

Practice location:
  • Phone: 352-200-2034
  • Fax:
Mailing address:
  • Phone: 17273998040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: