Healthcare Provider Details

I. General information

NPI: 1083525869
Provider Name (Legal Business Name): LEEANNE MARIE PINA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 TACOMA AVE S APT 616
TACOMA WA
98402-2645
US

IV. Provider business mailing address

308 TACOMA AVE S APT 616
TACOMA WA
98402-2645
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-9530
  • Fax:
Mailing address:
  • Phone: 503-719-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70161372
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: