Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11004717 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 11004717 | FL |
NPI | 1003439621 |
---|---|
Provider Name | Audrey Blendowski |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Zephyrhills, FL 33542-7505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 21/01/2021 |