Provider Demographics
NPI:1225114143
Name:BLACKBURN, ANGELA CHISUM (PHD, ARNP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CHISUM
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:PHD, ARNP
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Mailing Address - Street 1:1300 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2826
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-838-9961
Practice Address - Street 1:5149 N 9TH AVE
Practice Address - Street 2:SUITE G-27
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8756
Practice Address - Country:US
Practice Address - Phone:850-416-4417
Practice Address - Fax:850-416-7253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL2080252363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care