Provider Demographics
NPI:1053792754
Name:BLACKMER, KARA JEAN (RD, PA-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:JEAN
Last Name:BLACKMER
Suffix:
Gender:F
Credentials:RD, PA-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:JEAN
Other - Last Name:ANDRESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4100
Mailing Address - Fax:
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-697-3600
Practice Address - Fax:904-687-3927
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003163173AMedicaid
FL015111900Medicaid
FL015111900Medicaid