Provider Demographics
NPI:1376280081
Name:BLUFOX
Entity type:Organization
Organization Name:BLUFOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-438-8789
Mailing Address - Street 1:1340 SW 102ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2739
Mailing Address - Country:US
Mailing Address - Phone:305-438-8789
Mailing Address - Fax:
Practice Address - Street 1:1340 SW 102ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2739
Practice Address - Country:US
Practice Address - Phone:305-438-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590886323OtherFAMILY PRACTICE