Provider Demographics
NPI:1033543228
Name:VEGA, ENRIQUE (ARNP)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 E J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421-1602
Mailing Address - Country:US
Mailing Address - Phone:253-779-6040
Mailing Address - Fax:
Practice Address - Street 1:1623 E J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-1602
Practice Address - Country:US
Practice Address - Phone:253-779-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60402746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily