Individual
ANGELA GONZALES BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3940 MOSS OAK DR, JACKSONVILLE, FL 32277-1325
(904) 910-4688
Mailing address
3940 MOSS OAK DR, JACKSONVILLE, FL 32277-1325
(904) 910-4688
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11037313
FL
363LF0000X
Family Nurse Practitioner
Primary
11037313
FL
363LP0200X
Pediatric Nurse Practitioner
11037313
FL
Other
Enumeration date
02/15/2025
Last updated
02/15/2025
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