Provider Demographics
NPI:1194374751
Name:GOLDBLATT, JENNIFER S (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:GOLDBLATT
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 1:71 CONCERTO CT
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2761
Mailing Address - Country:US
Mailing Address - Phone:207-776-5755
Mailing Address - Fax:
Practice Address - Street 1:31 ROCHE BROS WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1032
Practice Address - Country:US
Practice Address - Phone:508-894-8740
Practice Address - Fax:508-894-8742
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty