Individual
TRACI LAUREN BLAKEBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
196 CARDIOLOGY DR, ROCK HILL, SC 29732-1174
(803) 324-5135
Mailing address
6136 HOLLAND ST, INDIAN LAND, SC 29707-7011
(615) 513-0082
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
26907
SC
Other
Enumeration date
06/14/2022
Last updated
06/14/2023
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