Provider Demographics
NPI:1447258066
Name:BLIZZARD, LISA S (SUPPORT COORDINATOR)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:S
Last Name:BLIZZARD
Suffix:
Gender:F
Credentials:SUPPORT COORDINATOR
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9526 ARGYLE FOREST BLVD
Mailing Address - Street 2:SUITE B2 PMB #309
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2825
Mailing Address - Country:US
Mailing Address - Phone:904-772-6442
Mailing Address - Fax:904-772-6443
Practice Address - Street 1:9447 BRUNTSFIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7176
Practice Address - Country:US
Practice Address - Phone:904-772-6442
Practice Address - Fax:904-772-6443
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker