Individual
LATISHA MICHELLE BLANCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
623 OAK ST, GREEN COVE SPRINGS, FL 32043-4313
(904) 531-9752
(904) 531-5149
Mailing address
141 DOSEL LN, ST AUGUSTINE, FL 32095-4859
(949) 313-5263
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11007925
FL
Other
Enumeration date
07/07/2020
Last updated
02/13/2023
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