Individual
MR. BLAKELY AUSTIN DEBOARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6000 49TH ST N, ST PETERSBURG, FL 33709-2114
(727) 521-4411
Mailing address
6918 NEOPOLITAN CT, APOLLO BEACH, FL 33572-1604
(813) 304-3383
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9444134
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11005487
FL
Other
Enumeration date
11/16/2019
Last updated
10/17/2022
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