MEDICARE: JACQUELINE BLIVEN

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	1097441	TX

General Provider Information

NPI Number	:	1962119990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BLIVEN

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	407-533-6836
Fax Number	:	407-770-0661

Provider Business Practice Location Address
First Line	:	5718 SPOHN DR STE 100
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4265
Country	:	US
Telephone Number	:	361-980-0808
Fax Number	:	361-980-0088

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	04/07/2026

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Directions to “ JACQUELINE BLIVEN ” Practice Location

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