Provider Demographics
NPI:1992288989
Name:BLAKLEY, ANDREW ELLIOTT (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ELLIOTT
Last Name:BLAKLEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HILTON RD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4097
Mailing Address - Country:US
Mailing Address - Phone:671-987-1542
Mailing Address - Fax:671-969-2946
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:671-645-5615
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURE2535163WG0000X
TXAP139003363LF0000X
GUNP0189363LF0000X
TX827646163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice