Healthcare Provider Details

I. General information

NPI: 1689265951
Provider Name (Legal Business Name): MR. JARYD ZAPATKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 BROADWAY STE 100
TACOMA WA
98402-3518
US

IV. Provider business mailing address

1148 BROADWAY STE 100
TACOMA WA
98402-3518
US

V. Phone/Fax

Practice location:
  • Phone: 253-722-2161
  • Fax:
Mailing address:
  • Phone: 253-722-2161
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61221231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: