Provider Demographics
NPI:1245192152
Name:BLANKS, JAZZMEN (CNA)
Entity type:Individual
Prefix:
First Name:JAZZMEN
Middle Name:
Last Name:BLANKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD DOVER BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2851
Mailing Address - Country:US
Mailing Address - Phone:260-445-0633
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD DOVER BLVD APT 1
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2851
Practice Address - Country:US
Practice Address - Phone:260-445-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA2503256376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty