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General NPI Number Information
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NPI Number | 1427924018
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Entity Type | Individual
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Provider Name | BLAKE TIMOTHY CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 7101 S PADRE ISLAND DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78412-4913
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Country | US
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Telephone | 361-761-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 CHLOE CAY ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78415-1471
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Country | US
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Telephone | 435-862-9852
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1233434
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License Number State | TX
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