Provider Demographics
NPI:1780474916
Name:BLANFORT, MARCEL
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:BLANFORT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8878 RUBY COVE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4937
Mailing Address - Country:US
Mailing Address - Phone:904-755-6458
Mailing Address - Fax:
Practice Address - Street 1:8878 RUBY COVE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4937
Practice Address - Country:US
Practice Address - Phone:904-755-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist