Blake Churchman

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

11037263 Issued in FL

Practice address

319 Howard LN
Melbourne, FL 32935-6935

Phone

(813) 361-0136

NPI assigned

Aug 24, 2020

Last updated

Jan 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1861005548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 HOWARD LN",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356935",
            "telephone_number": "813-361-0136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 HOWARD LN",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356935",
            "telephone_number": "813-361-0136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHMAN",
        "first_name": "BLAKE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "11037263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd E Christie, D.M.D
• Christine T Thomas MD PA
• Kelsey Ann Christman
• Kristi L Christman, PA-C
• Christopher J Prusinski DO PA
• Santy A Ciar
• Ciara Forde PT, DPT, CSCS PLLC
• Peter Casimir Ciechanowski, APRN
• Krzysztof Cieslik
• Joseph A Cimino, MD

• Psychiatric/Mental Health Nurse Practitioner in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.