Provider Demographics
NPI:1639209976
Name:CHINN, TAMARA A (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:CHINN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2923
Mailing Address - Country:US
Mailing Address - Phone:206-601-0907
Mailing Address - Fax:
Practice Address - Street 1:4540 SAND POINT WAY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3941
Practice Address - Country:US
Practice Address - Phone:206-527-1200
Practice Address - Fax:206-527-2514
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006863363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9643545Medicaid
WI9643545Medicaid
WA8856812Medicare ID - Type Unspecified