Provider Demographics
NPI:1790786739
Name:BLAISDELL, ERICA (RRT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 LAKEPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5791
Mailing Address - Country:US
Mailing Address - Phone:754-246-5499
Mailing Address - Fax:954-753-5680
Practice Address - Street 1:1181 LAKEPOINTE LN
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5791
Practice Address - Country:US
Practice Address - Phone:754-246-5499
Practice Address - Fax:954-753-5680
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT53252279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885359200Medicaid