Provider Demographics
NPI:1275704587
Name:EVANGELISTA, JOSEPHINE ARCILLA (ARNP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ARCILLA
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:MARGIE
Other - Last Name:LIZASO ARCILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-690-3421
Practice Address - Fax:425-690-9422
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60338171163W00000X, 363L00000X
CANP 15984363L00000X
WAAP60338791363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA511361OtherREGISTERED NURSE LICENSE
CA15984OtherNURSE PRACTITIONER LICENS