Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Breanna Blackledge

Individual provider Nurse Practitioner · NPI 1770434524

Breanna Blackledge is a Nurse Practitioner in Palm Coast, Florida. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Florida.

Years since qualifying
1
Licensed in
FL
In the registry since
2026

Practice location Address checks out

61 Memorial Medical Pkwy Ste 2811
Palm Coast, FL 32164-5999
Phone: (386) 586-1955
Fax: (386) 586-1959
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence APRN11044029 (FL)

Record details

NPI number1770434524
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 6, 2026
Last updated in NPPESJuly 2, 2026
Certification dateJuly 2, 2026
Mailing address770 W Granada Blvd Ste 101, Ormond Beach, FL 32174-5179

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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