Healthcare Provider Details

I. General information

NPI: 1740263755
Provider Name (Legal Business Name): FLORDELIZA TOLENTINO GAINEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FLORDELIZA SERRANO TOLENTINO RN

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 3RD STREET NE
AUBURN WA
98002
US

IV. Provider business mailing address

PO BOX 74008272
CHICAGO IL
60674-8272
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7750
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00155870
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: