Provider Demographics
NPI:1760107304
Name:BLUME, IMARA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:IMARA
Middle Name:
Last Name:BLUME
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PINE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2759
Mailing Address - Country:US
Mailing Address - Phone:689-290-6776
Mailing Address - Fax:689-209-1779
Practice Address - Street 1:100 E PINE ST STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2759
Practice Address - Country:US
Practice Address - Phone:689-290-6776
Practice Address - Fax:689-209-1779
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021261363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health