Individual
ELIZABETH ANN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1701 N 41ST AVE FL 33021, HOLLYWOOD, FL 33021-4216
(954) 881-0668
Mailing address
1701 N 41ST AVE FL 33021, HOLLYWOOD, FL 33021-4216
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11043962
FL
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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