Provider Demographics
NPI:1053954438
Name:BLAKEMAN, ANDREA (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BLAKEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:BLAKEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1614 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7037
Mailing Address - Country:US
Mailing Address - Phone:704-579-9046
Mailing Address - Fax:
Practice Address - Street 1:1131 SALUDA ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5776
Practice Address - Country:US
Practice Address - Phone:803-325-7744
Practice Address - Fax:803-325-1117
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23340363LC1500X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease