Healthcare Provider Details

I. General information

NPI: 1053944108
Provider Name (Legal Business Name): NATHANIEL OTT DNP, ARNP, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S STATE ST
TACOMA WA
98405-2845
US

IV. Provider business mailing address

2420 S STATE ST
TACOMA WA
98405-2845
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4000
  • Fax: 253-428-8440
Mailing address:
  • Phone: 253-426-4000
  • Fax: 253-428-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61288343
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP61288343
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61288343
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60791598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: