Individual provider Active NPI

Eileen M. Blackburn, PA-C

  • Medical Physician Assistant
  • Sunrise, FL
National Provider Identifier
1790738490
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 2181 Issued in FL
Practice address
14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865
Phone
(800) 424-3672
Fax
(954) 377-3042
NPI assigned
May 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 2181 FL Primary

Addresses

Primary practice location

14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865

Mailing address

206 2ND St E
Bradenton, FL 34208-1042
Phone (941) 746-5111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060622000042 FL Practitioner - Physician Assistant 8921010661 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 2181FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine of Florida, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790738490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 2ND ST E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081042",
            "telephone_number": "941-746-5111",
            "fax_number": "941-745-7206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 NW 14TH ST",
            "address_2": "SUITE 190",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232865",
            "telephone_number": "800-424-3672",
            "fax_number": "954-377-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "EILEEN",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 2181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

Verify at the official NPI Registry.