Provider Demographics
NPI:1316091002
Name:BLACKWELL, CHRISTOPHER WRIGHT (PHD, ARNP-C)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WRIGHT
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:PHD, ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 UNBRIDLED DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-6508
Mailing Address - Country:US
Mailing Address - Phone:507-375-4334
Mailing Address - Fax:
Practice Address - Street 1:308 E HAZEL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4023
Practice Address - Country:US
Practice Address - Phone:407-895-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9168694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP56811Medicare UPIN