Individual
TAMMIE L BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
220 E COUNTY RD, JERSEYVILLE, IL 62052-3125
(618) 498-8467
(618) 639-2017
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209007631
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12007750
CAQH ID
IL
Enumeration date
09/11/2009
Last updated
11/12/2024
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