Healthcare Provider Details

I. General information

NPI: 1124439724
Provider Name (Legal Business Name): TRISTAN SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24360 GARDEN DR APT 1305
EUCLID OH
44123-2468
US

IV. Provider business mailing address

24360 GARDEN DR APT 1305
EUCLID OH
44123-2468
US

V. Phone/Fax

Practice location:
  • Phone: 440-212-8337
  • Fax:
Mailing address:
  • Phone: 440-212-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0092498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: