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General NPI Number Information
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NPI Number | 1386121135
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Entity Type | Individual
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Provider Name | DESTYNI BLAYLOCK ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 1375 CASSAT AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7084
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Country | US
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Telephone | 904-388-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 137 MARINDA PL
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City | SAINT JOHNS
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State | FL
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Zip | 32259-1264
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Country | US
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Telephone | 904-803-1656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9380591
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License Number State | FL
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