Healthcare Provider Details

I. General information

NPI: 1710540893
Provider Name (Legal Business Name): ISEL AMADO BLANCO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST
MIAMI FL
33175-3530
US

IV. Provider business mailing address

3 MARYLAND FARMS STE 200
BRENTWOOD TN
37027-5780
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-3000
  • Fax:
Mailing address:
  • Phone: 615-346-8733
  • Fax: 888-468-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11039191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: