Healthcare Provider Details

I. General information

NPI: 1912994633
Provider Name (Legal Business Name): JENNIFER ELIZABETH BLAIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 STATE ROAD 54
TRINITY FL
34655-2263
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-4040
  • Fax: 727-376-8824
Mailing address:
  • Phone: 727-376-4040
  • Fax: 727-376-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3003862
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003862
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11047322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: