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General NPI Number Information
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NPI Number | 1114250966
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Entity Type | Individual
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Provider Name | TAMMIE L BLEVINS ANP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 220 E COUNTY RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-3125
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Country | US
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Telephone | 618-498-8467
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Fax | 618-639-2017
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Provider Business Mailing Address
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Address Line | 390 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2000
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Country | US
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Telephone | 618-498-7518
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Fax | 618-498-3052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209007631
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License Number State | IL
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