Provider Demographics
NPI:1326511395
Name:BLANCO, ROBERTO CARLOS (DNP, CRNA, ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:BLANCO
Suffix:
Gender:M
Credentials:DNP, CRNA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14470 SW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1714
Mailing Address - Country:US
Mailing Address - Phone:786-219-6240
Mailing Address - Fax:
Practice Address - Street 1:1400 NW 12TH AVE STE 75
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1003
Practice Address - Country:US
Practice Address - Phone:305-689-5792
Practice Address - Fax:305-689-1089
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9275537367500000X, 163W00000X, 363L00000X
FLAPRN11000864367500000X
OK0131254207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner