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General NPI Number Information
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NPI Number | 1235620196
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Entity Type | Individual
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Provider Name | BLANDINE DEENA THERNELUS MSN, ARNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 128 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5219
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Country | US
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Telephone | 813-915-5459
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Fax |
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Provider Business Mailing Address
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Address Line | 128 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5219
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Country | US
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Telephone | 813-915-5459
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9364601
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26380
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9364601
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License Number State | FL
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