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LATISHA MICHELLE BLANCHARD PMHNP

Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1619595733

Individual Registrant:
 LATISHA MICHELLE BLANCHARD PMHNP
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: --

Contact information for business:
109 CEJA WAY  ST AUGUSTINE, FL 32095-4852 US
Tel: 949-313-5263  Fax: --

Registration Information:
NPI: 1619595733
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Psychiatric/Mental Health
FLAPRN11007925

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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