Provider Demographics
NPI:1669880712
Name:BLAKE, CHRISTINA (FNP, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:
Credentials:FNP, IBCLC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3090
Mailing Address - Fax:520-309-2560
Practice Address - Street 1:EL RIO HEALTH
Practice Address - Street 2:839 W CONGRESS ST
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-309-2560
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-41735163WL0100X
AZ319183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant