Healthcare Provider Details

I. General information

NPI: 1679409320
Provider Name (Legal Business Name): XY ZA HOSMILLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S 38TH ST STE A
TACOMA WA
98418-6714
US

IV. Provider business mailing address

1210 TACOMA AVE S APT 629
TACOMA WA
98402-2027
US

V. Phone/Fax

Practice location:
  • Phone: 253-719-7767
  • Fax:
Mailing address:
  • Phone: 850-524-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70043941
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: