Provider Demographics
NPI:1659582716
Name:BLOT, BARBARA DESAMOURS (LM CPM)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DESAMOURS
Last Name:BLOT
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3618
Mailing Address - Country:US
Mailing Address - Phone:786-399-7080
Mailing Address - Fax:866-296-1719
Practice Address - Street 1:16600 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3618
Practice Address - Country:US
Practice Address - Phone:786-399-7080
Practice Address - Fax:866-296-1719
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW158176B00000X
FL9327259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340354800Medicaid