MEDICARE: TRISTAN LEIGH BARON ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP9349480	FL

General Provider Information

NPI Number	:	1396224499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN LEIGH BARON ARNP

Provider Business Mailing Address
First Line	:	3306 W VILLA ROSA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2947
Country	:	US
Telephone Number	:	813-505-0857
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3141
Country	:	US
Telephone Number	:	813-877-3739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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