Provider Demographics
NPI:1457625345
Name:BLACKLEY, TAMRIA DENISE (CPNP-PC)
Entity Type:Individual
Prefix:MISS
First Name:TAMRIA
Middle Name:DENISE
Last Name:BLACKLEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAK DR S
Mailing Address - Street 2:400A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5790
Mailing Address - Country:US
Mailing Address - Phone:979-285-2900
Mailing Address - Fax:979-285-2904
Practice Address - Street 1:208 OAK DR S
Practice Address - Street 2:400A
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5790
Practice Address - Country:US
Practice Address - Phone:979-285-2900
Practice Address - Fax:979-285-2904
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist