Provider Demographics
NPI:1154080562
Name:LUNA, BLAKE S (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:S
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:1050 N JAMES M CAMPBELL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2754
Practice Address - Country:US
Practice Address - Phone:931-381-2663
Practice Address - Fax:931-375-0300
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2023-10-13
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Provider Licenses
StateLicense IDTaxonomies
TN4915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant