Provider Demographics
NPI:1730267675
Name:BLANEY, KATHLEEN E (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:BLANEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N WYMORE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2859
Mailing Address - Country:US
Mailing Address - Phone:407-644-9002
Mailing Address - Fax:407-644-9004
Practice Address - Street 1:650 N WYMORE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2859
Practice Address - Country:US
Practice Address - Phone:407-644-9002
Practice Address - Fax:407-644-9004
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2209342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2209342OtherMEDICAL LICENSE
FLARNP2209342OtherMEDICAL LICENSE