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General NPI Number Information
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NPI Number | 1922494657
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Entity Type | Individual
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Provider Name | CHRISTIAN CONSTANCE BLACKWELL RN MSN NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1005 MAR WALT DRIVE INTERNAL MEDICINE DEPARTMENT
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6707
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Country | US
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Telephone | 850-863-8202
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Fax | 850-862-6148
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Provider Business Mailing Address
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Address Line | 1005 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6707
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Country | US
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Telephone | 850-863-8100
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Fax | 850-863-8548
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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 | APRN9171045
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License Number State | FL
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