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General NPI Number Information
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NPI Number | 1043432644
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Entity Type | Individual
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Provider Name | ANITA T BLENKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 1150 NW 14TH ST 6TH FLOOR
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City | MIAMI
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State | FL
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Zip | 33136-2137
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Country | US
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Telephone | 305-243-6732
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Fax | 305-243-8015
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Provider Business Mailing Address
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Address Line | 1974 NE 178TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2208
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Country | US
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Telephone | 305-947-6273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9101562
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License Number State | FL
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