Healthcare Provider Details

I. General information

NPI: 1629360631
Provider Name (Legal Business Name): NICOLE MARIE SOLANA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1000
US

IV. Provider business mailing address

440 ST HELENS AVE UNIT 310
TACOMA WA
98402-2407
US

V. Phone/Fax

Practice location:
  • Phone: 813-368-1636
  • Fax:
Mailing address:
  • Phone: 813-368-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number937
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: