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TINA MARIE BLACKLEY APRN FNP-C
NPI 1962937417
Nurse Practitioner - Family in Bangor, ME

Active since April 21, 2017PECOS EnrolledAccepts Medicare Assignment
900 BROADWAY, BANGOR, ME 04401(207) 907-3300(207) 907-1923 Get Directions Write a Review

NPPES record last updated: December 6, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 6, 2019, Jun 23, 2017, Apr 21, 2017 (3 updates tracked since 2017).

About Tina Marie Blackley Aprn Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TINA MARIE BLACKLEY APRN FNP-C (NPI 1962937417) is an individual family provider in Bangor, Maine, licensed in Maine (CNP171038) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS, is affiliated with Northern Light Eastern Maine Medical Center, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1962937417
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameTINA MARIE BLACKLEYCredential: APRN FNP-C
Location Address900 BROADWAYBangor, ME 04401
Mailing AddressC/o St Marys Health System - Provider Enrollment, Po Box 7291Lewiston, ME 04243-7291 · (207) 777-8560 · Fax (207) 777-8800
Phone(207) 907-3300
Fax(207) 907-1923
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateApril 21, 2017
Last NPPES UpdateDecember 6, 20193 updates tracked since enumeration
✔ NPI 1962937417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in ME · CNP171038
900 BROADWAY, Bangor, ME 04401
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tina Marie Blackley Aprn Fnp-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305103805
PECOS Enrollment IDI20260521003127
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Northern Light Eastern Maine Medical Center

Acute Care Hospitals · Bangor, ME
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number200033
Location489 State StreetBangor, ME 04401 · Penobscot County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 04401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.58 typical visit price
range $53.26 – $162.77
Typical copayment $20.64 (range $13.31 – $40.69)
Most-billed visit code 99203
Established Patient
$94.60 typical visit price
range $16.90 – $132.79
Typical copayment $23.65 (range $4.22 – $33.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HAILEY E BLACKWOOD FNPC
Nurse Practitioner
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300
JOSHUA JAMES DUCHENE DO
Family Medicine
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3777
MARILYN L MICHAUD FNP
Nurse Practitioner (Family)
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300
ILSA ANNETTA SHULMAN MD
Internal Medicine
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300
RODRIGO ROXAS MD
Family Medicine
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3777
KERRY RIKER M. D.
Internal Medicine
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300
ZACHARY MITCHELL GREENIER PA
Physician Assistant
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300
MRS. ADRIENNE MIRANDA EWER FNP
Nurse Practitioner (Family)
900 BROADWAY
BANGOR, ME 04401
Penobscot County (207) 907-3300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tina Blackley's NPI number?

The NPI number for Tina Blackley is 1962937417. It was assigned to this individual provider in the NPPES registry on April 21, 2017.

Where is Tina Blackley located?

Tina Blackley practices at 900 Broadway, Bangor, ME 04401. The listed phone number is (207) 907-3300.

What is Tina Blackley's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Tina Blackley enrolled in Medicare?

Yes. Tina Blackley is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Tina Blackley affiliated with any hospitals?

According to CMS data, Tina Blackley is affiliated with Northern Light Eastern Maine Medical Center.

When was this NPI record last updated?

The NPPES record for Tina Blackley was last updated on December 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.