Healthcare Provider Details
I. General information
NPI: 1336775337
Provider Name (Legal Business Name): TITISHA MASTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 03/21/2020
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US
IV. Provider business mailing address
1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US
V. Phone/Fax
- Phone: 808-433-5447
- Fax:
- Phone: 808-433-5447
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 171000000X |
| Taxonomy | Military Health Care Provider |
| License Number | APRN-3798 |
| License Number State | HI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: