Basic Information
| Provider Information | |||||||||
| NPI: | 1982259784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | ELLIOTT | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 SKYLINE DR | ||||||||
| Address2: | STE 4 | ||||||||
| City: | LADY LAKE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321594588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524511521 | ||||||||
| FaxNumber: | 3524313173 | ||||||||
| Practice Location | |||||||||
| Address1: | 5776 SAINT AUGUSTINE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173088047 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | AP142483 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 363LP0808X | AP142483 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | APRN11006947 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.