Provider Demographics
NPI:1912887415
Name:GENERATIONAL HEALTH INNOVATIONS
Entity type:Organization
Organization Name:GENERATIONAL HEALTH INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MPH
Authorized Official - Phone:954-557-2775
Mailing Address - Street 1:PO BOX 6994
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6994
Mailing Address - Country:US
Mailing Address - Phone:954-557-2775
Mailing Address - Fax:903-805-4928
Practice Address - Street 1:844 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2042
Practice Address - Country:US
Practice Address - Phone:954-557-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty