Provider Demographics
NPI:1235708652
Name:BLANKINSHIP, AMANDA ROSTRON (CRNA)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROSTRON
Last Name:BLANKINSHIP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 CHARING CROSS
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6829
Mailing Address - Country:US
Mailing Address - Phone:843-307-5975
Mailing Address - Fax:
Practice Address - Street 1:2301 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4720
Practice Address - Country:US
Practice Address - Phone:912-264-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-CRNA000257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered