MEDICARE: ELIZABETH ANN BLAKE PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11043962	FL

General Provider Information

NPI Number	:	1619832508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN BLAKE PMHNP-BC

Provider Business Mailing Address
First Line	:	3191 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6755
Country	:	US
Telephone Number	:	941-883-4518
Fax Number	:	941-249-4356

Provider Business Practice Location Address
First Line	:	3191 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6755
Country	:	US
Telephone Number	:	941-883-4518
Fax Number	:	941-249-4356

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	05/28/2026

Similar Medicare Providers

1396575403 — YARIMA REGLA PALMERO CASTELLANOS PMHNP-BC
Practice Location Address:

3191 HARBOR BLVD STE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 941-883-4518
Practice Fax:

1336134717 — PHILLIP V CARRACHER LCSW
Practice Location Address:

3191 HARBOR BLVD , SUITE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 941-766-9555
Practice Fax: 941-766-1511

1912992132 — DR. BERNARDO J ARIAS MD
Practice Location Address:

3191 HARBOR BLVD STE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 239-223-2751
Practice Fax: 239-561-2933

1104811272 — SEABREEZE BEHAVIORAL MEDICINE PA
Practice Location Address:

3191 HARBOR BLVD , SUITE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 941-766-9555
Practice Fax: 941-766-1511

1811982473 — JUDITH A TIBERIA ARNP
Practice Location Address:

3191 HARBOR BLVD STE A , SUITE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 941-766-9555
Practice Fax: 941-766-1511

1235347535 — DENNIS LEONE M.D.
Practice Location Address:

3191 HARBOR BLVD STE A
PORT CHARLOTTE, FL
33952-6755

Practice Phone: 393-387-3232
Practice Fax:

Directions to “ ELIZABETH ANN BLAKE PMHNP-BC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.