Provider Demographics
NPI:1508007329
Name:BLADERGROEN, KACY (ARNP)
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:
Last Name:BLADERGROEN
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 1:2150 SE SALERNO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6572
Mailing Address - Country:US
Mailing Address - Phone:772-223-5777
Mailing Address - Fax:
Practice Address - Street 1:2150 SE SALERNO RD STE 200
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6572
Practice Address - Country:US
Practice Address - Phone:772-223-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264276363LP0200X
FLAPRN9264276363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics