Provider Demographics
NPI:1437424181
Name:DE LA VEGA, AMBER (ARNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DE LA VEGA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:J
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1387
Practice Address - Country:US
Practice Address - Phone:253-680-6200
Practice Address - Fax:253-752-6076
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60268683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily