Individual
BLAIZE XZAVIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4910 CREEKSIDE DR STE D, CLEARWATER, FL 33760-4034
(727) 593-0003
Mailing address
24808 PERMIT WAY, LAND O LAKES, FL 34639-6323
(808) 561-8234
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
252003
FM
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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