Individual
KENNETH BLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21260 OLEAN BLVD STE 202A, PORT CHARLOTTE, FL 33952-6742
(941) 625-1550
Mailing address
12387 SAGEWOOD DR, VENICE, FL 34293-0327
(561) 329-6408
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11012755
FL
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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