Provider Demographics
NPI:1013644962
Name:BLITCH, DEBBIE MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:MARIE
Last Name:BLITCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ALCAZAR AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8743
Mailing Address - Country:US
Mailing Address - Phone:360-229-1367
Mailing Address - Fax:
Practice Address - Street 1:4340 S HOPKINS AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6689
Practice Address - Country:US
Practice Address - Phone:321-222-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021254363LF0000X
FLRN9382877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse