Healthcare Provider Details

I. General information

NPI: 1093122525
Provider Name (Legal Business Name): BEATRICE GILZINE-BLACKWOOD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 FLATLANDS AVE
BROOKLYN NY
11234-2223
US

IV. Provider business mailing address

5002 FLATLANDS AVE
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 916-527-4740
  • Fax:
Mailing address:
  • Phone: 718-400-1222
  • Fax: 718-360-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349762
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR263821
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number686918-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR263821
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR263821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: