Provider Demographics
NPI:1033645148
Name:FLARIDA, BLAKE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BLAKE
Middle Name:
Last Name:FLARIDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N BEAUREGARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1732
Mailing Address - Country:US
Mailing Address - Phone:703-717-4148
Mailing Address - Fax:703-717-4149
Practice Address - Street 1:1600 N BEAUREGARD ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1732
Practice Address - Country:US
Practice Address - Phone:703-717-4148
Practice Address - Fax:703-717-4149
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner