Individual provider · Type 1 NPI

Tina Marie Blackley, APRN FNP-C

Family Nurse Practitioner · Bangor, ME

NPI number 1962937417 Active

Practice location

900 Broadway
Bangor, ME 04401

Fax (207) 907-1923

Mailing address

C/o St Marys Health System - Provider Enrollment, PO Box 7291
Lewiston, ME 04243-7291

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000XCNP171038 (ME)

Family Nurse Practitioner: Definition to come...

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About NPI 1962937417

Tina Marie Blackley, APRN FNP-C's National Provider Identifier is 1962937417, issued on Apr 21, 2017. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Bangor, ME. The record was last updated on Dec 6, 2019.