MEDICARE: CAROL BLAKE MSN, RN, CNS, CRNFA

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	364S00000X	Clinical Nurse Specialist	023	AZ

General Provider Information

NPI Number	:	1710926530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL BLAKE MSN, RN, CNS, CRNFA

Provider Business Mailing Address
First Line	:	4091 E NISBET RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4767
Country	:	US
Telephone Number	:	602-971-8599
Fax Number	:	602-971-3887

Provider Business Practice Location Address
First Line	:	4091 E NISBET RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4767
Country	:	US
Telephone Number	:	602-971-8599
Fax Number	:	602-971-3887

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/16/2025

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