Tidewater TLC Family Care PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TIDEWATER TLC FAMILY CARE PLLC

Practice address

745 Battlefield Blvd N
Chesapeake, VA 23320-0305

Phone

(757) 436-6959

Fax

(757) 549-1933

NPI assigned

Oct 12, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vanessa A Blowe, MD FAAFP

Title

Practice Owner Doctor

Phone

(757) 436-6959

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386632495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 BATTLEFIELD BLVD N",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233200305",
            "telephone_number": "757-436-6959",
            "fax_number": "757-549-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 BATTLEFIELD BLVD N",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233200305",
            "telephone_number": "757-436-6959",
            "fax_number": "757-549-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER TLC FAMILY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLOWE",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE OWNER DOCTOR",
        "authorized_official_telephone_number": "757-436-6959",
        "authorized_official_credential": "MD  FAAFP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "54190784",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMAHEALTH PPO AND HMO",
            "identifier": "57786",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PPO",
            "identifier": "393970",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shannon Katherine Tipton, RESIDENT IN COUNSELI

• Family Medicine Physician in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.