Individual
JOHN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
2605 W SWANN AVE, STE 600, TAMPA, FL 33609-4039
(813) 876-7073
(813) 877-1277
Mailing address
2605 W SWANN AVE, STE 600, TAMPA, FL 33609-4039
(813) 876-7073
(813) 877-1277
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1158122
FL
Other
Enumeration date
12/06/2007
Last updated
12/06/2007
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