Healthcare Provider Details

I. General information

NPI: 1295709715
Provider Name (Legal Business Name): JUDY D ESTROFF ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

IV. Provider business mailing address

1019 PACIFIC AVE STE. 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-4742
  • Fax: 253-472-8790
Mailing address:
  • Phone: 253-722-1556
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004381
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: