Basic Information
| Provider Information | |||||||||
| NPI: | 1033645148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLARIDA | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N BEAUREGARD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174148 | ||||||||
| FaxNumber: | 7037174149 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N BEAUREGARD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174148 | ||||||||
| FaxNumber: | 7037174149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024175062 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.