Organization
TIDEWATER TLC FAMILY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA A BLOWE MD FAAFP (PRACTICE OWNER DOCTOR)
(757) 436-6959
Entity
Organization
Contact information
Practice address
745 BATTLEFIELD BLVD N, CHESAPEAKE, VA 23320-0305
(757) 436-6959
(757) 549-1933
Mailing address
745 BATTLEFIELD BLVD N, CHESAPEAKE, VA 23320-0305
(757) 436-6959
(757) 549-1933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
393970
ANTHEM BCBS PPO
—
01
—
54190784
TRICARE
—
01
—
57786
OPTIMAHEALTH PPO AND HMO
—
Enumeration date
10/12/2005
Last updated
08/22/2020
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