Healthcare Provider Details

I. General information

NPI: 1376483958
Provider Name (Legal Business Name): NICHOLAS BLAZICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MORELEY AVE
AKRON OH
44320-2026
US

IV. Provider business mailing address

633 MORELEY AVE
AKRON OH
44320-2026
US

V. Phone/Fax

Practice location:
  • Phone: 330-780-5855
  • Fax:
Mailing address:
  • Phone: 330-780-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberTG874405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: