Individual provider · Type 1 NPI

Simone Blackburn

Women's Health Nurse Practitioner · Philadelphia, PA

NPI number 1669309464 Active

Practice location

111 S 11th St
Philadelphia, PA 19107-4870

Call (714) 655-9299 Map

Mailing address

4224 Otter Street
Philadelphia, PA 19104

Specialties and licenses

Taxonomy	Code	License
Women's Health Nurse Practitioner Primary	363LW0102X	SP032163 (PA)

Women's Health Nurse Practitioner: Definition to come...

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About NPI 1669309464

Simone Blackburn's National Provider Identifier is 1669309464, issued on May 6, 2026. The primary taxonomy on file is Women's Health Nurse Practitioner (363LW0102X), and the practice location is in Philadelphia, PA. The record was last updated on May 6, 2026.