Healthcare Provider Details

I. General information

NPI: 1891559472
Provider Name (Legal Business Name): TRICIA A LIND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRICIA LIND

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 NE GLISAN ST STE 100
PORTLAND OR
97213-3069
US

IV. Provider business mailing address

5330 NE GLISAN ST STE 100
PORTLAND OR
97213-3069
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9700
  • Fax: 503-215-9701
Mailing address:
  • Phone: 503-215-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10047718
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: