Provider Demographics
NPI:1831203561
Name:BLACKBURN, TAMMY B (CRNA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:B
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 926098
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-6098
Mailing Address - Country:US
Mailing Address - Phone:713-426-1669
Mailing Address - Fax:713-868-9416
Practice Address - Street 1:1211 HIGHWAY 6
Practice Address - Street 2:SUITE 70
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4941
Practice Address - Country:US
Practice Address - Phone:281-620-3295
Practice Address - Fax:281-313-3632
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509446367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6386Medicare ID - Type UnspecifiedPROVIDER #