Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Charles Edward Blake, FNP-BC

Individual provider Family Nurse Practitioner · NPI 1972666154

Mr. Charles Edward Blake, FNP-BC is a Nurse Practitioner in Glendale, Arizona. Qualified in 2005, 21 years ago. Practices with Enticare PC, a 19-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
21
Licensed in
AZ
In the registry since
2006
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

17215 N 72nd Dr Bldg D
Glendale, AZ 85308-8558
Phone: (480) 214-9000
Fax: (480) 214-9999
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP2395 (AZ)

Record details

NPI number1972666154
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BC
Sole proprietorNo
NPI enumeratedDecember 18, 2006
Last updated in NPPESMay 9, 2024
Certification dateMay 9, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Enticare Pc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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