Active NPI
Nicole Blesie
- Speech-Language Pathologist
- Brandon, FL
National Provider Identifier
1174772792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SZ4600
- Practice address
- 602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900 - Phone
- (813) 653-1149
- Fax
- (813) 654-6644
- NPI assigned
- Sep 18, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SZ4600 | FL | Primary |
Addresses
Primary practice location
602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Mailing address
602 Vonderburg Dr
Suite 201
Brandon, FL 33511-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5610 | SC | MD | Social Worker |
| SZ4600 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221696000000",
"number": "1174772792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 VONDERBURG DR",
"address_2": "SUITE 201",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 VONDERBURG DR",
"address_2": "SUITE 201",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115900",
"telephone_number": "813-653-1149",
"fax_number": "813-654-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLESIE",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-18",
"last_updated": "2008-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SZ4600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.