Individual
AMY ELIZABETH BLANCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1121 5TH AVE STE 100, FORT WORTH, TX 76104-4386
(817) 423-8585
(817) 423-8458
Mailing address
P.O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP142394
TX
Other
Enumeration date
06/13/2019
Last updated
07/24/2019
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