Healthcare Provider Details

I. General information

NPI: 1871418616
Provider Name (Legal Business Name): LUXIA BLACKWOOD NURSE PRACTITIONER IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 EASTWOOD LN
VALLEY STREAM NY
11581-2426
US

IV. Provider business mailing address

228 PARK AVE S
NEW YORK NY
10003-0103
US

V. Phone/Fax

Practice location:
  • Phone: 516-217-7845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LUXIA BLACKWOOD
Title or Position: AGNP-BC
Credential:
Phone: 719-206-6000