Individual
DR. MICHELLE ANTOINETTE BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17 DAVIS BLVD, TAMPA, FL 33606-3475
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME136819
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100117300
—
FL
01
—
MSM6V
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/12/2015
Last updated
10/27/2020
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