Healthcare Provider Details

I. General information

NPI: 1407575269
Provider Name (Legal Business Name): NICOLE SAMANTHA CAPARAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 POINT FOSDICK DR STE 320
GIG HARBOR WA
98335-1706
US

IV. Provider business mailing address

4700 POINT FOSDICK DR STE 320
GIG HARBOR WA
98335-1706
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-8664
  • Fax:
Mailing address:
  • Phone: 253-272-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: