Provider Demographics
NPI:1861989535
Name:BLASI, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLASI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CARMELLA
Other - Last Name:SAVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4335 WATERFORD LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9727
Mailing Address - Country:US
Mailing Address - Phone:585-355-5282
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4190
Practice Address - Country:US
Practice Address - Phone:813-708-8346
Practice Address - Fax:866-270-9831
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342731363LF0000X
NYF3427311363LF0000X
FLAPRN11032065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily