Provider Demographics
NPI:1508310145
Name:BLAKE, NATALIE (ARNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8042 WURZBACH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3823
Mailing Address - Country:US
Mailing Address - Phone:210-201-2801
Mailing Address - Fax:
Practice Address - Street 1:8042 WURZBACH RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3823
Practice Address - Country:US
Practice Address - Phone:210-201-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-184901363L00000X, 363LA2100X
FLARNP9346194363LA2100X, 363LA2200X
TX1171220363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19116400Medicaid
FL0BKO0OtherBLUE CROSS AND BLUE SHIELD
FL19116400Medicaid