Provider Demographics
NPI:1396712865
Name:BLOUIN, WILLIAM R (MSN,ARNP,CPNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:BLOUIN
Suffix:
Gender:M
Credentials:MSN,ARNP,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8272
Mailing Address - Fax:305-663-6868
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8272
Practice Address - Fax:305-663-6868
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2140482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307133200Medicaid