Provider Demographics
NPI:1326497140
Name:EZBICKI, BLAIR (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:
Last Name:EZBICKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1001 SE MONTEREY CMNS
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:772-878-3757
Mailing Address - Fax:
Practice Address - Street 1:1001 SE MONTEREY CMNS
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3329
Practice Address - Country:US
Practice Address - Phone:772-286-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9202291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily