Provider Demographics
NPI:1639922040
Name:HANLIN, BLAKE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:HANLIN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 SWEETHOME RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-2511
Mailing Address - Country:US
Mailing Address - Phone:397-572-4719
Mailing Address - Fax:
Practice Address - Street 1:3621 SWEETHOME RD
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-2511
Practice Address - Country:US
Practice Address - Phone:397-572-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36046363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner