Healthcare Provider Details

I. General information

NPI: 1023021763
Provider Name (Legal Business Name): BIANCA TRISTAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E SHAW AVE STE 128
FRESNO CA
93710-8025
US

IV. Provider business mailing address

1551 E SHAW AVE
FRESNO CA
93710-8024
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0490
  • Fax: 559-320-0494
Mailing address:
  • Phone: 559-320-0490
  • Fax: 559-320-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN390406
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF11252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: