Provider Demographics
NPI:1992285308
Name:BLANZY, JEREMY AURBREY (FNP-BC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:AURBREY
Last Name:BLANZY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK BOULEVARD
Mailing Address - Street 2:SUITE 400E
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-844-5400
Mailing Address - Fax:423-844-5434
Practice Address - Street 1:1 MEDICAL PARK BOULEVARD
Practice Address - Street 2:SUITE 400E
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-844-5400
Practice Address - Fax:423-844-5434
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24573363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health