Healthcare Provider Details

I. General information

NPI: 1194377705
Provider Name (Legal Business Name): SARAH PHILLIPS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 03/30/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 42ND ST NE
TACOMA WA
98422-2424
US

IV. Provider business mailing address

1201 PACIFIC AVE STE 400
TACOMA WA
98402-4381
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-4902
  • Fax:
Mailing address:
  • Phone: 206-245-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60980902
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60980902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: