Provider Demographics
NPI:1851726517
Name:FERNANDEZ BLANCAS, NIURKA M
Entity Type:Individual
Prefix:
First Name:NIURKA
Middle Name:M
Last Name:FERNANDEZ BLANCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 SW 43RD DR
Mailing Address - Street 2:APT 131
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4180
Mailing Address - Country:US
Mailing Address - Phone:786-320-2955
Mailing Address - Fax:
Practice Address - Street 1:12821 SW 43RD DR
Practice Address - Street 2:APT 131
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4180
Practice Address - Country:US
Practice Address - Phone:305-796-1021
Practice Address - Fax:305-223-8399
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA187412163WH0200X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002938000Medicaid