Provider Demographics
NPI:1881952224
Name:BLINICK, CHALICE ANN (FNP)
Entity type:Individual
Prefix:
First Name:CHALICE
Middle Name:ANN
Last Name:BLINICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5351
Mailing Address - Country:US
Mailing Address - Phone:480-664-2753
Mailing Address - Fax:480-664-2818
Practice Address - Street 1:2525 S RURAL RD STE 4N
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2442
Practice Address - Country:US
Practice Address - Phone:480-664-2753
Practice Address - Fax:480-664-2818
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ727846Medicaid
AZ727846Medicaid