Provider Demographics
NPI:1841452273
Name:BLANKS, SONJI (APRN)
Entity type:Individual
Prefix:MS
First Name:SONJI
Middle Name:
Last Name:BLANKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280455
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-0455
Mailing Address - Country:US
Mailing Address - Phone:813-895-1936
Mailing Address - Fax:
Practice Address - Street 1:9340 N 56TH ST STE 222C
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5536
Practice Address - Country:US
Practice Address - Phone:813-895-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2882042163WC1600X
FLAPRN11001073363LP2300X
FL11001073363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6937217 96Medicaid