Provider Demographics
NPI:1497798540
Name:BLANDINA, ILIA M (CNM)
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:M
Last Name:BLANDINA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ILIA
Other - Middle Name:M
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2800 S SEACREST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7965
Mailing Address - Country:US
Mailing Address - Phone:561-742-3929
Mailing Address - Fax:561-742-3931
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7965
Practice Address - Country:US
Practice Address - Phone:561-742-3929
Practice Address - Fax:561-742-3931
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1644502367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303927700Medicaid
FLE7731Medicare PIN