Provider Demographics
NPI:1336667666
Name:BLAIR TURNER, AUDRENITA
Entity Type:Individual
Prefix:
First Name:AUDRENITA
Middle Name:
Last Name:BLAIR TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 BRANT TREE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7086
Mailing Address - Country:US
Mailing Address - Phone:813-334-1294
Mailing Address - Fax:
Practice Address - Street 1:12907 BRANT TREE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7086
Practice Address - Country:US
Practice Address - Phone:813-334-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities