MEDICARE: MRS. KATHLEEN E BLANEY A.R.N.P.

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	363L00000X	Nurse Practitioner	ARNP2209342	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ARNP2209342	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1730267675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN E BLANEY A.R.N.P.

Provider Business Mailing Address
First Line	:	128 FIG TREE RUN
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 FIG TREE RUN
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4067
Country	:	US
Telephone Number	:	321-277-8832
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/14/2026

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