Provider Demographics
NPI:1659004034
Name:OSBORNE, ANDREW COLE (PAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:COLE
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2845
Mailing Address - Country:US
Mailing Address - Phone:253-426-4000
Mailing Address - Fax:253-428-8440
Practice Address - Street 1:2420 S STATE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2845
Practice Address - Country:US
Practice Address - Phone:253-426-4000
Practice Address - Fax:253-428-8440
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61334301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2224022Medicaid