Provider Demographics
NPI:1720120355
Name:PERMANN, JENNIFER CLAIRE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:PERMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N M ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1524
Mailing Address - Country:US
Mailing Address - Phone:253-404-1486
Mailing Address - Fax:
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-627-0666
Practice Address - Fax:253-627-2879
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003477363AM0700X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPE6823OtherREGENCE BLUE SHIELD
WA8416323Medicaid
WA8416323Medicaid
WAAB11530Medicare ID - Type Unspecified