Provider Demographics
NPI:1902849938
Name:BLAIR, TAMMIE MAE (NP)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:MAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PAGE MILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2073
Mailing Address - Country:US
Mailing Address - Phone:888-731-8994
Mailing Address - Fax:
Practice Address - Street 1:103 PAGE MILL ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168949363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH092875-23OtherSTATE LICENSE
MDR248550OtherSTATE LICENSE
CT12742OtherSTATE LICENSE - APRN
CT214952OtherSTATE LICENSE - RN
DCRN1024450OtherSTATE LICENSE
RI03987OtherSTATE LICENSE
WV117969OtherSTATE LICENSE
VA0024168949OtherSTATE LICENSE
CA752978OtherSTATE LICENSE - RN
CA19503OtherSTATE LICENSE - APRN