Provider Demographics
NPI:1952873515
Name:LAFORTEZA, ANGELINA ABRAHAMSON (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:ABRAHAMSON
Last Name:LAFORTEZA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:LAFORTEZA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:25 N E ST APT 204
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3106
Mailing Address - Country:US
Mailing Address - Phone:253-394-6933
Mailing Address - Fax:
Practice Address - Street 1:25 N E ST APT 204
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3106
Practice Address - Country:US
Practice Address - Phone:253-394-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60337451163W00000X
WAAP61029318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse