Individual
BLAKE JARED GARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4901 GRANDE DR, PENSACOLA, FL 32504-5935
(850) 477-7042
(850) 474-9060
Mailing address
4901 GRANDE DR, PENSACOLA, FL 32504-5935
(850) 477-7042
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN9315576
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003238800
—
FL
05
—
125956
—
AL
01
—
592-13614
BLUE CROSS BLUE SHIELD
AL
01
—
G00M5
BLUE CROSS BLUE SHIELD
FL
01
—
P00929451
MEDICARE RAILROAD
—
Enumeration date
01/18/2011
Last updated
11/10/2011
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