MEDICARE: LORETTA BLANCHARD NP

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	363L00000X	Nurse Practitioner	APRN11011984	FL
2	363L00000X	Nurse Practitioner	12857-NP	OH

General Provider Information

NPI Number	:	1104103613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA BLANCHARD NP

Provider Business Mailing Address
First Line	:	5821 S WILLIAMSON BLVD STE 204
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6102
Country	:	US
Telephone Number	:	386-231-6300
Fax Number	:	386-322-6165

Provider Business Practice Location Address
First Line	:	5821 S WILLIAMSON BLVD
Second Line	:	STE 204
City	:	PORT ORANGE
State	:	FL
Zip	:	32128
Country	:	US
Telephone Number	:	386-231-6300
Fax Number	:	386-322-6165

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

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	04/15/2026

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Directions to “ LORETTA BLANCHARD NP” Practice Location

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