Individual
THERESA A JOVANOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
33501 1ST WAY S, FEDERAL WAY, WA 98003-6208
(253) 838-2400
(253) 874-1634
Mailing address
1100 9TH AVE, MS M4-PA, SEATTLE, WA 98101-2756
(206) 515-5811
(206) 515-5886
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10004066
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039594
LABOR AND INDUSTRIES #
WA
01
—
0335JO
BLUE SHIELD #
WA
05
—
8362543
—
WA
01
—
970030800
RAILROAD MC#
WA
01
—
US7233432
AETNA SPECIALIST PIN
WA
Enumeration date
01/09/2007
Last updated
12/31/2012
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