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NPI Code Detail

MEDICARE: MR. JACKSON BLANTON

MEDICARE: MR. JACKSON BLANTON
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
1106S00000XBehavior TechnicianRBT-23-279488FL

General Provider Information

NPI Number : 1821774001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACKSON BLANTON
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-431-6243
Fax Number : 844-431-6243
Provider Business Practice Location Address
First Line : 5020 GUNN HWY STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33624-6361
Country : US
Telephone Number : 844-854-1116
Fax Number : 844-854-1116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2023
Last Update Date : 01/19/2026

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Directions to “ MR. JACKSON BLANTON ” Practice Location

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