Mysti Blizzard, APN
Individual provider Active NPI Family Nurse Practitioner · Vineland, NJ
NPI 1982117339 · NPPES record last updated Nov 8, 2017
Key facts
- NPI
- 1982117339
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 26NJ00765900 (NJ)
- Practice address
- 1505 W Sherman Ave Ste 101
Vineland, NJ 08360-7059 - Phone
- (856) 696-9550
- NPI assigned
- Nov 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Health Care, Inc.
Practice addresses (Care Compare)
785 W Sherman Ave
Vineland, NJ 08360-6913
Phone (856) 451-4700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180117001238 | NJ | Practitioner - Nurse Practitioner | 9638438781 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ00765900 | NJ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Care, Inc. | Current |
Accepting new patients | |
| Community Health Care, Inc. | Current |
Accepting new patients | |
| Southern Oncology Hematology Assoc | Current |
Accepting new patients |
Locations
30 N Pearl St
Bridgeton, NJ 08302
335 Delsea Dr N
Glassboro, NJ 08028
Phone (856) 863-5720
100 Medical Center Way
Somers Point, NJ 08244
Phone (609) 272-0506
785 W Sherman Ave
Vineland, NJ 08360
1505 W Sherman Ave
#101
Vineland, NJ 08360
Phone (856) 696-9550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 26NJ00765900 | NJ | Yes |
Addresses
Primary practice location
1505 W Sherman Ave Ste 101
Vineland, NJ 08360-7059
Mailing address
1505 W Sherman Ave Ste 101
Vineland, NJ 08360-7059
Phone (856) 696-9550
Other providers in Vineland, NJ
- BJ'S Wholesale Club Inc.
- Gina Black
- Kyle Blalock
- Phillip Blandino
- Eric Pollack Blazar
- Suzanne Blizzard
- David H Blom
- Blooming Within Counseling LLC
- Prasanthi Bobba
- Ezra Ralph Bobo
All providers in Vineland, NJ · Family Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.