Healthcare Provider Details

I. General information

NPI: 1235708652
Provider Name (Legal Business Name): AMANDA ROSTRON BLANKINSHIP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 PARKWOOD DR
BRUNSWICK GA
31520-4720
US

IV. Provider business mailing address

3030 CHARING CROSS
BRUNSWICK GA
31525-6829
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-0014
  • Fax:
Mailing address:
  • Phone: 843-307-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberGAA-CRNA000257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: