Healthcare Provider Details

I. General information

NPI: 1013541903
Provider Name (Legal Business Name): JESSICA TO DNP, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

2011 N 153RD PL
SHORELINE WA
98133-6336
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax:
Mailing address:
  • Phone: 206-453-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60406678
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61073864
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: