Provider Demographics
NPI:1750303178
Name:BLANDON-HENDRIX, DANIEL EDWARD (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:BLANDON-HENDRIX
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-8000
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE CB 7050
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-3003
Practice Address - Country:US
Practice Address - Phone:984-974-3701
Practice Address - Fax:984-974-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1701352363L00000X
NC5009127363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305097100Medicaid
U3161WMedicare PIN
P19604Medicare UPIN
FL305097100Medicaid