Provider Demographics
NPI:1023751781
Name:BLANCHARD, COURTNEY AUDREY (APRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:AUDREY
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:AUDREY
Other - Last Name:COBBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-284-2229
Mailing Address - Fax:813-377-1680
Practice Address - Street 1:14014 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4237
Practice Address - Country:US
Practice Address - Phone:813-284-2229
Practice Address - Fax:813-377-1681
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021541363LF0000X
FL11021541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLWW5RZOtherBLUE CROSS BLUE SHIELD
FL117033800Medicaid