Individual
JAQUELINE DARE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1610 CLIMBING DAYFLOWER DR, RUSKIN, FL 33570-4949
(910) 584-0980
Mailing address
1610 CLIMBING DAYFLOWER DR, RUSKIN, FL 33570-4949
(910) 584-0980
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11024186
FL
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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