Healthcare Provider Details

I. General information

NPI: 1710791041
Provider Name (Legal Business Name): TEFFANIE LENE LLAMADA REPASZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 KITSAP WAY
BREMERTON WA
98312-2447
US

IV. Provider business mailing address

8908 BETHEL BURLEY RD SE
PORT ORCHARD WA
98367-7815
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-7780
  • Fax:
Mailing address:
  • Phone: 360-434-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61639870
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61639870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: