Provider Demographics
NPI:1972486082
Name:BLANC, ANOUL
Entity type:Individual
Prefix:
First Name:ANOUL
Middle Name:
Last Name:BLANC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 REISSWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1313
Mailing Address - Country:US
Mailing Address - Phone:252-299-6859
Mailing Address - Fax:
Practice Address - Street 1:4521 REISSWOOD LOOP
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1313
Practice Address - Country:US
Practice Address - Phone:252-299-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9557439163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)