Provider Demographics
NPI:1609486026
Name:BAIN, JOANNA HOPE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HOPE
Last Name:BAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:CHRISTINE
Other - Last Name:HOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1304 FAWCETT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-1900
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:
Practice Address - Street 1:2502 S UNION AVENUE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-841-4653
Practice Address - Fax:253-446-3973
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61051606363A00000X
WAPA61051606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant