Individual
JESSICA BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3340 TAMIAMI TRL, PORT CHARLOTTE, FL 33952-8088
(941) 764-5858
(941) 764-1657
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9119370
FL
Other
Enumeration date
10/17/2024
Last updated
12/04/2024
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