Healthcare Provider Details

I. General information

NPI: 1235307836
Provider Name (Legal Business Name): TRAVIS MICHAEL PAOLI ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

PO BOX 5215
TACOMA WA
98415-0215
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-4901
  • Fax:
Mailing address:
  • Phone: 253-403-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007962
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: