Healthcare Provider Details

I. General information

NPI: 1154058824
Provider Name (Legal Business Name): TRISHA M FAMBRO APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MAIN ST STE 500
SALT LAKE CITY UT
84101-2275
US

IV. Provider business mailing address

222 S MAIN ST STE 500
SALT LAKE CITY UT
84101-2275
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-9765
  • Fax:
Mailing address:
  • Phone: 801-747-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997723-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: