Provider Demographics
NPI:1215593397
Name:CLEMETSON BLAKE, NYOKA (ARNP)
Entity Type:Individual
Prefix:
First Name:NYOKA
Middle Name:
Last Name:CLEMETSON BLAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MAYORCA CT
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1101
Mailing Address - Country:US
Mailing Address - Phone:561-809-6759
Mailing Address - Fax:
Practice Address - Street 1:106 MAYORCA CT
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1101
Practice Address - Country:US
Practice Address - Phone:561-809-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily