Provider Demographics
NPI:1598148793
Name:PRETYKA, TENLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TENLY
Middle Name:ANN
Last Name:PRETYKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TENLY
Other - Middle Name:ANN
Other - Last Name:DEMURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-2608
Practice Address - Country:US
Practice Address - Phone:206-543-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60731135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical