MEDICARE: MISS BEATRICE GILZINE-BLACKWOOD NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	349762	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R263821	MD
3	163W00000X	Registered Nurse	686918-1	NY
4	363LF0000X	Family Nurse Practitioner	R263821	MD
5	363L00000X	Nurse Practitioner	R263821	MD

General Provider Information

NPI Number	:	1093122525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BEATRICE GILZINE-BLACKWOOD NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	5002 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-400-1222
Fax Number	:	718-360-0637

Provider Business Practice Location Address
First Line	:	5002 FLATLANDS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2223
Country	:	US
Telephone Number	:	916-527-4740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	06/17/2026

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