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John Michael Blanco Mata, NP
Gerontology Nurse Practitioner in Prescott, Arizona
NPI 1639871247

John Michael Blanco Mata is a Gerontology Nurse Practitioner based in Humboldt, AZ and is specialized in Gerontology. John Michael Blanco Mata practices in Prescott, AZ and has the professional credentials of NP. The NPI Number for John Michael Blanco Mata is 1639871247 and holds a License No. 267971 (Arizona).

The current practice location address for John Michael Blanco Mata is 3250 Gateway Blvd Ste 112, Prescott, AZ and can be reached out via phone at 708-248-0049. You can also correspond with John Michael Blanco Mata through the mailing address at PO BOX 522, HUMBOLDT, AZ - 86329-0522 (mailing address contact number: 708-248-0049).

Location: 3250 Gateway Blvd Ste 112, Prescott, AZ, 86329-0522
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1639871247
Provider Name
John Michael Blanco Mata
Credential
NP
Provider Entity Type
Individual
Gender
Male
Address
3250 Gateway Blvd Ste 112, Prescott, AZ, 86329-0522
Phone Number
708-248-0049
Fax Number
Provider Enumeration Date
03/20/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3250 Gateway Blvd Ste 112
City
Prescott
State
Arizona
Zip
86303-6856
Phone Number
708-248-0049
Fax Number
person
Provider Business Mailing Address Details
Address
Po Box 522
City
Humboldt
State
Arizona
Zip
86329-0522
Phone Number
708-248-0049
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
267971 (Arizona)
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Acute Care
Taxonomy
363LA2100X
License No.
267971 (Arizona)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Adult Health
Taxonomy
363LA2200X
License No.
267971 (Arizona)
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Critical Care Medicine
Taxonomy
363LC0200X
License No.
267971 (Arizona)
Definition
Definition to come...
person
Provider's Taxonomy Details 5
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Gerontology
Taxonomy
363LG0600X
License No.
267971 (Arizona)
Definition
Definition to come...
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