Provider Demographics
NPI:1386223337
Name:BLAMICK, KARI ELIZABETH (AT STUDENT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ELIZABETH
Last Name:BLAMICK
Suffix:
Gender:F
Credentials:AT STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21630 LAKE SENECA RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736
Mailing Address - Country:US
Mailing Address - Phone:352-630-8570
Mailing Address - Fax:
Practice Address - Street 1:21630 LAKE SENECA RD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736
Practice Address - Country:US
Practice Address - Phone:352-630-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program