Provider Demographics
NPI:1497287437
Name:BLANCO, CHRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 SW 8TH ST
Mailing Address - Street 2:UNIT 505
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3892
Mailing Address - Country:US
Mailing Address - Phone:786-564-6858
Mailing Address - Fax:
Practice Address - Street 1:2855 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6516
Practice Address - Country:US
Practice Address - Phone:954-981-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily