Individual
ELYSSA BLISSENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PA
Contact information
Practice address
2065 HERSCHEL ST, JACKSONVILLE, FL 32204-3817
(904) 387-4050
(904) 387-4860
Mailing address
2065 HERSCHEL ST, JACKSONVILLE, FL 32204-3817
(904) 387-4050
(904) 387-4860
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0069426
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252461900
—
FL
Enumeration date
08/02/2006
Last updated
10/15/2008
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