Individual
MR. STEPHEN JEFFERY BLACKHURST II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
444 CHAMPAGNE CIR, PORT ORANGE, FL 32127-6787
(407) 545-0877
Mailing address
444 CHAMPAGNE CIR, PORT ORANGE, FL 32127-6787
(407) 545-0877
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9273773
FL
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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