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General NPI Number Information
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NPI Number | 1497472781
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Entity Type | Individual
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Provider Name | BLAKE A GELB
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Gender | Male
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 601 E DIXIE AVE STE 901
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City | LEESBURG
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State | FL
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Zip | 34748-7308
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Country | US
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Telephone | 352-728-2404
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Fax | 352-787-7401
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Provider Business Mailing Address
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Address Line | 601 E DIXIE AVE STE 901
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City | LEESBURG
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State | FL
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Zip | 34748-7308
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Country | US
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Telephone | 352-728-2404
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Fax | 352-787-7401
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11021808
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License Number State | FL
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