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General NPI Number Information
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NPI Number | 1639922040
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Entity Type | Individual
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Provider Name | BLAKE HANLIN FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 3621 SWEETHOME RD
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City | ASHLAND CITY
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State | TN
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Zip | 37015-2511
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Country | US
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Telephone | 397-572-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 SWEETHOME RD
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City | ASHLAND CITY
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State | TN
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Zip | 37015-2511
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Country | US
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Telephone | 397-572-4719
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 36046
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License Number State | TN
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