Individual
KIA R BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8320 W SUNRISE BLVD STE 208, PLANTATION, FL 33322-5432
(800) 640-3451
Mailing address
PO BOX 1200, PLEASANT GROVE, UT 84062-1200
(800) 640-3451
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
11025598
FL
363LG0600X
Gerontology Nurse Practitioner
11025598
FL
Other
Enumeration date
07/18/2023
Last updated
09/13/2024
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