Provider Demographics
NPI:1275511941
Name:BLANKENSHIP, TERRY D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:D
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8782
Mailing Address - Country:US
Mailing Address - Phone:850-936-4249
Mailing Address - Fax:850-936-4249
Practice Address - Street 1:2317 CRESCENT RD
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-8782
Practice Address - Country:US
Practice Address - Phone:850-936-4249
Practice Address - Fax:850-936-4249
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198870367500000X
AL1-102783367500000X
GARN129660 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305497700Medicaid
FLG3260OtherBSFL
FLG3260OtherBSFL