Blaylock, Clyde

Blaylock, Clyde is an individual health care provider with primary practice located at 8725 N Wickham Rd Ste 301 , Melbourne FL 32940-2240. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Blaylock, Clyde can be contacted via phone (321) 434-9200.

Contact Information

Primary practice address
8725 N Wickham Rd Ste 301 Melbourne FL 32940-2240
Phone: (321) 434-9200
Fax: (321) 434-9202
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X ARNP9210359 Florida

Profile Details

NPI number 1154738821
LBN Legal business name Blaylock, Clyde
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2014
Last updated Apr 8th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1154738821 NPPES
Florida Other HX161Z MEDICARE
Florida MEDICAID 014541700 MEDICARE
Florida Other HX161Y MEDICARE

Popular Providers