Healthcare Provider Details

I. General information

NPI: 1255974150
Provider Name (Legal Business Name): CHRISTY E BLACKBURN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 SW 19TH AVENUE RD
OCALA FL
34471-7859
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-4422
  • Fax: 352-671-4423
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: