1215459763 NPI number — JOHANNA BLANCAFLOR WELLINGTON APRN

Table of content: JOHANNA BLANCAFLOR WELLINGTON APRN (NPI 1215459763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215459763 NPI number — JOHANNA BLANCAFLOR WELLINGTON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLINGTON
Provider First Name:
JOHANNA
Provider Middle Name:
BLANCAFLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
JOHANNA
Provider Other Middle Name:
BLANCAFLOR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, FNP-BC, NP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215459763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-274-8200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9320 STATE ROAD 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-842-8411
Provider Business Practice Location Address Fax Number:
877-917-2336
Provider Enumeration Date:
07/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN11024240 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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