Organization
HYDRATION EXPERIENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOCIANNA BLACKWELL APRN (NURSE PRACTITIONER)
(954) 765-9521
Entity
Organization
Contact information
Practice address
1329 NW 10TH ST, DANIA BEACH, FL 33004-2341
(954) 765-9521
Mailing address
1329 NW 10TH ST, DANIA BEACH, FL 33004-2341
(954) 765-9521
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356657704
—
GA
Enumeration date
02/28/2021
Last updated
02/28/2021
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