Individual
MR. GUSTAVO DARIO BLANCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN9268820
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011063000
—
FL
01
—
HU281Y
MEDICARE
FL
Enumeration date
11/15/2013
Last updated
04/08/2019
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