Provider Demographics
NPI:1215697875
Name:BLACKFORD, DENISE (FNP)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:
Last Name:BLACKFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4609
Mailing Address - Country:US
Mailing Address - Phone:305-330-0112
Mailing Address - Fax:
Practice Address - Street 1:714 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4609
Practice Address - Country:US
Practice Address - Phone:305-330-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11003950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP11003950OtherFAMILY NURSE PRACTITIONER