Provider Demographics
NPI:1386427326
Name:BLAIN, TAMMY LEE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:BLAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 MISSION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-5632
Mailing Address - Country:US
Mailing Address - Phone:361-935-7751
Mailing Address - Fax:
Practice Address - Street 1:1406 E RED RIVER ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5521
Practice Address - Country:US
Practice Address - Phone:361-575-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily