Healthcare Provider Details

I. General information

NPI: 1184134371
Provider Name (Legal Business Name): JAZMYN PRINCESS CARROLL TANG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAZMYN PRINCESS CARROLL ARNP

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11025 CANYON RD E STE A
PUYALLUP WA
98373-4268
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-548-0453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60926405
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60926405
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: