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General NPI Number Information
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NPI Number | 1912887415
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Entity Type | Organization
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Legal Business Name | GENERATIONAL HEALTH INNOVATIONS
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 844 S FLEISHEL AVE
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City | TYLER
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State | TX
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Zip | 75701-2042
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Country | US
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Telephone | 954-557-2775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6994
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City | TYLER
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State | TX
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Zip | 75711-6994
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Country | US
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Telephone | 954-557-2775
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Fax | 903-805-4928
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER A BLAKE
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Credential |
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Telephone | 954-557-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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