Basic Information
| Provider Information | |||||||||
| NPI: | 1568484533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOSSEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | FRYE | ||||||||
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| Credential: | CNM, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 83 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078415281 | ||||||||
| FaxNumber: | 4076489879 | ||||||||
| Practice Location | |||||||||
| Address1: | 83 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078415281 | ||||||||
| FaxNumber: | 4076489879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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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 | 363LX0001X | ARNP569342 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LW0102X | ARNP569342 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LX0001X | RN569342 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 305653800 | 05 | FL | MEDICAID | ARNP569342 | 01 | FL | MEDICAL LICENSE | OTHER |