Individual
TINA MARIE BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-C
Contact information
Practice address
900 BROADWAY, BANGOR, ME 04401
(207) 907-3300
(207) 907-1923
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP171038
ME
Other
Enumeration date
04/21/2017
Last updated
12/06/2019
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