Healthcare Provider Details

I. General information

NPI: 1861989535
Provider Name (Legal Business Name): ELIZABETH BLASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CARMELLA SAVINE

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE STE 160
TAMPA FL
33609-4190
US

IV. Provider business mailing address

4335 WATERFORD LANDING DR
LUTZ FL
33558-9727
US

V. Phone/Fax

Practice location:
  • Phone: 813-708-8346
  • Fax: 866-270-9831
Mailing address:
  • Phone: 585-355-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342731
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3427311
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: