Provider Demographics
NPI:1952496408
Name:BLATNIK, ANITA MARIE (APN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:BLATNIK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-983-5266
Mailing Address - Fax:
Practice Address - Street 1:UT STUDENT HEALTH CTR
Practice Address - Street 2:1800 VOLUNTEER BLVD
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-5066
Practice Address - Fax:865-974-5205
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN97696163WG0000X
TNAPN6871363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice