Provider Demographics
NPI:1861077323
Name:SAMUEL, BLESSY JOB (APRN)
Entity type:Individual
Prefix:
First Name:BLESSY
Middle Name:JOB
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9122 BOLECK PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7079
Mailing Address - Country:US
Mailing Address - Phone:301-221-5736
Mailing Address - Fax:
Practice Address - Street 1:9122 BOLECK PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7079
Practice Address - Country:US
Practice Address - Phone:301-221-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011128363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health