Healthcare Provider Details

I. General information

NPI: 1265274864
Provider Name (Legal Business Name): JUSTINE BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 N NEBRASKA AVE
TAMPA FL
33604-3103
US

IV. Provider business mailing address

1465 GENE ST
WINTER PARK FL
32789-4815
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax:
Mailing address:
  • Phone: 813-863-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: