Healthcare Provider Details

I. General information

NPI: 1255941605
Provider Name (Legal Business Name): KRISTIN VASSER BLANCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CURRENCY CIR
LAKE MARY FL
32746-2115
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 407-804-6133
  • Fax: 866-447-9143
Mailing address:
  • Phone: 239-432-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11003769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: