Provider Demographics
NPI:1013771229
Name:BLANCO, KATHERINE (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 SW 74TH CT STE 1911
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3178
Mailing Address - Country:US
Mailing Address - Phone:305-842-2283
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 74TH CT STE 1911
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3178
Practice Address - Country:US
Practice Address - Phone:305-842-2283
Practice Address - Fax:305-503-7338
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9557506363L00000X
FLAPRN11031063363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner