Provider Demographics
NPI:1679660658
Name:HICKS, TARA LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:HICKS
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 1:901 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4411
Mailing Address - Country:US
Mailing Address - Phone:206-363-0710
Mailing Address - Fax:
Practice Address - Street 1:1111 E COLUMBIA ST
Practice Address - Street 2:#107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-1090
Practice Address - Country:US
Practice Address - Phone:206-296-6300
Practice Address - Fax:209-296-6090
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007418363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health