Provider Demographics
NPI:1477934875
Name:BLAZEL, JODI (ANP-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BLAZEL
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22335 EXPLORATION DR STE 2005
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-2015
Mailing Address - Country:US
Mailing Address - Phone:301-863-7310
Mailing Address - Fax:
Practice Address - Street 1:22335 EXPLORATION DR STE 2005
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2015
Practice Address - Country:US
Practice Address - Phone:301-863-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203482363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health