Healthcare Provider Details

I. General information

NPI: 1952496408
Provider Name (Legal Business Name): ANITA MARIE BLATNIK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UT STUDENT HEALTH CTR 1800 VOLUNTEER BLVD
KNOXVILLE TN
37996-0001
US

IV. Provider business mailing address

239 WILSON AVE
MARYVILLE TN
37804
US

V. Phone/Fax

Practice location:
  • Phone: 865-974-5066
  • Fax: 865-974-5205
Mailing address:
  • Phone: 865-983-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN97696
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN6871
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: