Provider Demographics
NPI:1558912584
Name:JARDEL, BLANCA ELCY (SA-C)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ELCY
Last Name:JARDEL
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 STONEY FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4182
Mailing Address - Country:US
Mailing Address - Phone:631-455-1384
Mailing Address - Fax:
Practice Address - Street 1:1137 STONEY FALLS BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4182
Practice Address - Country:US
Practice Address - Phone:631-455-1384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19-282246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant