Provider Demographics
NPI:1104103613
Name:BLANCHARD, LORETTA (NP)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PLATINUM PT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5702
Mailing Address - Country:US
Mailing Address - Phone:407-878-0910
Mailing Address - Fax:
Practice Address - Street 1:707 PLATINUM PT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5702
Practice Address - Country:US
Practice Address - Phone:407-878-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12857-NP363L00000X
FLAPRN11011984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner