MEDICARE: VALERIE CAROL BLATZ APRN

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	258187	GA

General Provider Information

NPI Number	:	1285467647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE CAROL BLATZ APRN

Provider Business Mailing Address
First Line	:	2098 COLERAIN RD
Second Line	:
City	:	KINGSLAND
State	:	GA
Zip	:	31548-3925
Country	:	US
Telephone Number	:	912-227-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	96279 BRADY POINT RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-7076
Country	:	US
Telephone Number	:	904-321-0088
Fax Number	:

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	10/13/2025

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