Healthcare Provider Details

I. General information

NPI: 1336309921
Provider Name (Legal Business Name): NANCY G. BLADSACKER DNP, FNP-BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 OLD PASS RD
GULFPORT MS
39501-2585
US

IV. Provider business mailing address

4502 OLD PASS RD
GULFPORT MS
39501-2585
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-9977
  • Fax: 228-863-9912
Mailing address:
  • Phone: 228-863-9977
  • Fax: 228-863-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR678341
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR678341
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: