Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theodore Green

Individual provider Family Nurse Practitioner · NPI 1053954776

Theodore Green is a Nurse Practitioner in Tacoma, Washington. Qualified in 2019, 7 years ago. Practices with Capital Medical Center Physicians LLC, a 59-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
7
Licensed in
WA
In the registry since
2019
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Practice location Address checks out

3716 Pacific Ave Ste E
Tacoma, WA 98418-7836
Phone: (253) 474-5141
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP61015452 (WA)

Record details

NPI number1053954776
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 25, 2019
Last updated in NPPESMarch 18, 2021
Certification dateMarch 18, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Capital Medical Center Physicians Llc — 59 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Tacoma