Blay Longevity
Internal Medicine in Pensacola, FL. Organization (NPI-2).
NPI number1124842299
StatusActive
Last updated in NPPESNov 14, 2024
Details
- NPI
- 1124842299
- Entity type
- Organization (NPI-2)
- Legal business name
- Blay Longevity
- Organization subpart
- No
- Enumeration date
- Nov 14, 2024
- Certification date
- Nov 14, 2024
- Last updated
- Nov 14, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Practice location
1010 N 12th Ave Ste 307Pensacola, FL 32501-3492
Phone 407-617-4361
Mailing address
1010 N 12th Ave Ste 307Pensacola, FL 32501-3492
Phone 407-617-4361
Authorized official
Nicole Blay
Nurse Practitioner
4076174361
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