Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | AP61188031 | WA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP61188031 | WA |
NPI | 1477126399 |
---|---|
Provider Name | Tegan C Jones |
First Address | Gig Harbor, WA 98332-5812 |
Second Address | Gig Harbor, WA 98332-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2188099 | (05) | WA |