Nicole Bladin, ARNP
Individual provider Active NPI Nurse Practitioner · Melbourne Beach, FL
NPI 1275955692 · NPPES record last updated Feb 11, 2021
Key facts
- NPI
- 1275955692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 9398062 (FL)
- Practice address
- 206 Ash Ave
Melbourne Beach, FL 32951-2402 - Phone
- (815) 701-6507
- NPI assigned
- Jan 21, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240209002189 | FL | Order and Referring Only - Nurse Practitioner | 6608008172 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9398062 | FL | MD | Nurse Practitioner |
| 209011131 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sebastian Chiropractic PA | Current |
Accepting new patients |
Locations
1627 US Highway 1
Ste 111
Sebastian, FL 32958
Phone (772) 388-1148
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209011131 | IL | |
| Nurse Practitioner | 363L00000X | 9398062 | FL | Yes |
Addresses
Primary practice location
206 Ash Ave
Melbourne Beach, FL 32951-2402
Mailing address
206 Ash Ave
Melbourne Beach, FL 32951-2402
Phone (815) 701-6507
Other practice location 1
8701 N US Highway 1
Sebastian, FL 32958-7524
Phone (815) 701-6507
Other providers in Melbourne Beach, FL
- Align Physical Therapy, Inc.
- Jacquelyn Elizabeth Antal
- Autism Therapy ABA Services LLC
- Beachnspeech
- Kara Beres
- Joseph E Bonar
- Brett C Reynolds OD PA
- Carl V Bundschuh
- Jimmie Dean Canole
- Benita Carson
All providers in Melbourne Beach, FL · Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.