Provider Demographics
NPI:1578021481
Name:LETT, DESTINY ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:ROSE
Last Name:LETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 198TH ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4146
Mailing Address - Country:US
Mailing Address - Phone:714-421-1427
Mailing Address - Fax:
Practice Address - Street 1:2505 S 38TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7372
Practice Address - Country:US
Practice Address - Phone:253-274-3943
Practice Address - Fax:253-274-2948
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60920614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily