Healthcare Provider Details

I. General information

NPI: 1376466714
Provider Name (Legal Business Name): FATIMA TICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY STE 200
TACOMA WA
98402-3400
US

IV. Provider business mailing address

328 PARK ST APT 103
SHELTON WA
98584-2292
US

V. Phone/Fax

Practice location:
  • Phone: 360-280-0866
  • Fax:
Mailing address:
  • Phone: 360-280-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.RN.61289566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: