Blaise, Danice

Blaise, Danice is an sole proprietor health care provider with primary practice located at 684 State Road 60 W , Lake Wales FL 33853-4419. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Blaise, Danice can be contacted via phone (863) 949-4868.

Contact Information

Primary practice address
684 State Road 60 W Lake Wales FL 33853-4419
Phone: (863) 949-4868
Fax: (863) 223-8549
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2019045102 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X CV2000213 Indiana
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / General Practice 208D00000X ACN1418 Florida

Profile Details

NPI number 1255829966
LBN Legal business name Blaise, Danice
Credentials MD,MBA
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 27th, 2018
Last updated Oct 27th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255829966 NPPES
Florida MEDICAID 115752400

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