Provider Demographics
NPI:1578082806
Name:BLANKE, ANDREW (CAA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BLANKE
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 W HIBISCUS BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2627
Mailing Address - Country:US
Mailing Address - Phone:321-837-3820
Mailing Address - Fax:
Practice Address - Street 1:1775 W HIBISCUS BLVD STE 215
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2627
Practice Address - Country:US
Practice Address - Phone:321-837-3820
Practice Address - Fax:321-837-3820
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL415367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant