Healthcare Provider Details

I. General information

NPI: 1831870914
Provider Name (Legal Business Name): JESSA BUENAVISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N PEARL ST
TACOMA WA
98406-2530
US

IV. Provider business mailing address

2102 N PEARL ST
TACOMA WA
98406-2530
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-8822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70135783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: