Provider Demographics
NPI:1043945041
Name:BLIZZARD, MARK ASHFORD (FNP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ASHFORD
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SPRINGCREST DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28578-9096
Mailing Address - Country:US
Mailing Address - Phone:919-222-4255
Mailing Address - Fax:
Practice Address - Street 1:2704 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9460
Practice Address - Country:US
Practice Address - Phone:919-736-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016589207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine