Provider Demographics
NPI:1861442287
Name:BLANCHE, KRISTINE M (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:BLANCHE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SUNSET CAY RD # ORC
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3726
Mailing Address - Country:US
Mailing Address - Phone:516-312-1972
Mailing Address - Fax:516-676-2809
Practice Address - Street 1:24 SUNSET CAY RD
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3726
Practice Address - Country:US
Practice Address - Phone:516-312-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114782363AM0700X
NY009513363AM0700X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208600000XAllopathic & Osteopathic PhysiciansSurgery