Healthcare Provider Details

I. General information

NPI: 1518778331
Provider Name (Legal Business Name): TRISTYN SYPHERD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14514 W VENTURA ST
SURPRISE AZ
85379-5727
US

IV. Provider business mailing address

14514 W VENTURA ST
SURPRISE AZ
85379-5727
US

V. Phone/Fax

Practice location:
  • Phone: 480-202-3079
  • Fax:
Mailing address:
  • Phone: 480-202-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF01250695
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: