Provider Demographics
NPI:1538130794
Name:BLOSSOM, ROBIN JEANNE-ANN (RNC FNP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:JEANNE-ANN
Last Name:BLOSSOM
Suffix:
Gender:F
Credentials:RNC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40232 JUNCTION DR
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-8719
Mailing Address - Country:US
Mailing Address - Phone:559-658-6420
Mailing Address - Fax:559-658-6460
Practice Address - Street 1:40232 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8719
Practice Address - Country:US
Practice Address - Phone:559-658-6420
Practice Address - Fax:559-658-6460
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ005132Medicaid
R98836Medicare UPIN
CAZZZ005132Medicaid