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LATISHA MICHELLE BLANCHARD PMHNP
Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1619595733
Individual Registrant: LATISHA MICHELLE BLANCHARD PMHNP
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
189 SAN MARCO AVE SAINT AUGUSTINE, FL 32084-2733 US
Tel: 949-313-5263 Fax: --
Tel: 949-313-5263 Fax: --
Contact information for business:
109 CEJA WAY ST AUGUSTINE, FL 32095-4852 US
Tel: 949-313-5263 Fax: --
Tel: 949-313-5263 Fax: --
Registration Information:
NPI: 1619595733
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Psychiatric/Mental Health | FL | APRN11007925 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
