Most Relevant Information
Provider Data
| NPI Number: | 1003072059 |
| Provider Name: | PATRICIA DIANE BLASICK PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 1390 |
Most Important Dates
| Enumeration Date: | 07/30/2008 |
| Last Updated: | 04/16/2019 |
Provider Practice Location
1508 TOMBRAS AVE
EAST RIDGE
TN
374122720
Practice Location Phone/Fax
| Phone: | 4238674969 |
| Fax: | 4238674971 |
Provider Mailing Location
1508 TOMBRAS AVE
EAST RIDGE
TN
374122720
Provider Mailing Phone/Fax
| Phone: | 4238674969 |
| Fax: | 4238674971 |