Provider Demographics
NPI:1316426992
Name:TACQUARD, BLAIRE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:BLAIRE
Middle Name:MARIE
Last Name:TACQUARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 COUNTY ROAD 160
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-6198
Mailing Address - Country:US
Mailing Address - Phone:832-282-9355
Mailing Address - Fax:
Practice Address - Street 1:2306 COUNTY ROAD 160
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-6198
Practice Address - Country:US
Practice Address - Phone:832-282-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX944378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse