Active NPI
John Donald Blackburn II
- Athletic Trainer
- Eagle Lake, FL
National Provider Identifier
1700417490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 5880
- Practice address
- 1995 Thunder Rd
Eagle Lake, FL 33839-3086 - Phone
- (863) 224-4085
- NPI assigned
- Jan 31, 2020
- Last updated
- Jan 31, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 5880 | FL | Primary |
Addresses
Primary practice location
1995 Thunder Rd
Eagle Lake, FL 33839-3086
Mailing address
367 Holly Ridge Rd
Winter Haven, FL 33880-1114
Phone (863) 224-4085
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5880 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1700417490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "367 HOLLY RIDGE RD",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338801114",
"telephone_number": "863-224-4085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1995 THUNDER RD",
"city": "EAGLE LAKE",
"state": "FL",
"postal_code": "338393086",
"telephone_number": "863-224-4085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "JOHN",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-31",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "5880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle Lake, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.