Basic Information
| Provider Information | |||||||||
| NPI: | 1124398482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCCOLA | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 6TH AVE | ||||||||
| Address2: | APT 503 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536205015 | ||||||||
| FaxNumber: | 2536205831 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 MLK JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534414743 | ||||||||
| FaxNumber: | 2536205831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00125750 | WA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | AP60296557 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.