Blu Haven Salon LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

BLU HAVEN SALON LLC

Doing business as

Blu Haven Cranial Prosthetics

Practice address

16259 Tisons Bluff Rd
Jacksonville, FL 32218-0141

Phone

(904) 431-2131

NPI assigned

Jan 26, 2026

Last updated

Jan 26, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Guerline DivraNPI 1417807215

Title

Owner/Manager

Phone

(904) 431-2131

Specialties & licenses 1

Addresses

Other names 1

• Blu Haven Cranial Prosthetics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Guerline Divra

  • Prosthetics Case Management
  • Jacksonville, FL
  • NPI 1417807215
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1790634566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 DUVAL STATION RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180800",
            "telephone_number": "904-431-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16259 TISONS BLUFF RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322180141",
            "telephone_number": "904-431-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLU HAVEN SALON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-26",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "DIVRA",
        "authorized_official_first_name": "GUERLINE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "904-431-2131"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blu Haven Cranial Prosthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.