Provider Demographics
NPI:1235620196
Name:THERNELUS, BLANDINE DEENA (MSN, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BLANDINE
Middle Name:DEENA
Last Name:THERNELUS
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5219
Mailing Address - Country:US
Mailing Address - Phone:813-915-5459
Mailing Address - Fax:
Practice Address - Street 1:128 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5219
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364601363LF0000X
TN26380363LF0000X
FLAPRN9364601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily