Provider Demographics
NPI:1689022030
Name:BLAKE, ALEENA VIALVA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ALEENA
Middle Name:VIALVA
Last Name:BLAKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALEENA
Other - Middle Name:
Other - Last Name:VIALVA-WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6505 ECTOR PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5403
Mailing Address - Country:US
Mailing Address - Phone:904-329-9785
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF0516152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003184549AMedicaid
FL018284300Medicaid
GA003184549AMedicaid