Healthcare Provider Details

I. General information

NPI: 1790605137
Provider Name (Legal Business Name): TRISTAN SAVANNA PRIAULX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N LITCHFIELD RD
GOODYEAR AZ
85338-1277
US

IV. Provider business mailing address

15322 W WETHERSFIELD RD
SURPRISE AZ
85379-9180
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax:
Mailing address:
  • Phone: 717-246-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number339985
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: