Provider Demographics
NPI:1134368087
Name:BLANKINSHIP, TAWNY N (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAWNY
Middle Name:N
Last Name:BLANKINSHIP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1496
Mailing Address - Country:US
Mailing Address - Phone:530-559-4070
Mailing Address - Fax:
Practice Address - Street 1:4112 E COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9680
Practice Address - Country:US
Practice Address - Phone:916-447-6337
Practice Address - Fax:916-283-9939
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical