Provider Demographics
NPI:1245786912
Name:BLACKWOOD, NAVIA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:NAVIA
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5586 SE COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8062
Mailing Address - Country:US
Mailing Address - Phone:305-321-1904
Mailing Address - Fax:
Practice Address - Street 1:5586 SE COLLINS AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8062
Practice Address - Country:US
Practice Address - Phone:305-321-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12885172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12885OtherLICENSE
FLAL12885OtherLICENSE