Provider Demographics
NPI:1104419498
Name:BLATT, ABBEY JO (DNP, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:ABBEY
Middle Name:JO
Last Name:BLATT
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:MS
Other - First Name:ABBEY
Other - Middle Name:JO
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 BATTLEGROUND AVE APT 142
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8401
Mailing Address - Country:US
Mailing Address - Phone:304-771-7036
Mailing Address - Fax:
Practice Address - Street 1:5500 W FRIENDLY AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4368
Practice Address - Country:US
Practice Address - Phone:336-373-1996
Practice Address - Fax:336-482-2320
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014093363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics