Provider Demographics
NPI:1699454595
Name:TRUONG, JESSICA (AP61463253)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:AP61463253
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 27TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5426
Mailing Address - Country:US
Mailing Address - Phone:206-335-2306
Mailing Address - Fax:
Practice Address - Street 1:16549 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5308
Practice Address - Country:US
Practice Address - Phone:206-533-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP6143253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily