Provider Demographics
NPI:1679093280
Name:BLAAKMAN, HOLLY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BLAAKMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 JEFFERSON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3270
Mailing Address - Country:US
Mailing Address - Phone:585-385-6070
Mailing Address - Fax:585-385-6071
Practice Address - Street 1:755 JEFFERSON RD STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3270
Practice Address - Country:US
Practice Address - Phone:585-385-6070
Practice Address - Fax:585-385-6071
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0208361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant