Provider Demographics
NPI:1629266366
Name:DAMICO, TRAVIS ARMOND (MN, ARNP)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:ARMOND
Last Name:DAMICO
Suffix:
Gender:M
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MELROSE AVE E APT 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4721
Mailing Address - Country:US
Mailing Address - Phone:206-325-5003
Mailing Address - Fax:
Practice Address - Street 1:5002 KITSAP WAY STE 200
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2359
Practice Address - Country:US
Practice Address - Phone:360-782-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007865363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health