MEDICARE: MS. BONNIE BLANK ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0102X	Maternal Newborn Registered Nurse	ARNP3351907	FL

General Provider Information

NPI Number	:	1255605440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONNIE BLANK ARNP

Provider Business Mailing Address
First Line	:	4920 SW 77TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-6053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 SW 77TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-6053
Country	:	US
Telephone Number	:	305-666-6511
Fax Number	:	305-669-6438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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