Healthcare Provider Details

I. General information

NPI: 1124347620
Provider Name (Legal Business Name): TRISTIN ADIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4178 HIGHBRIDGE RD
FAIRFAX VT
05454-5446
US

IV. Provider business mailing address

152 HOME AVE
BURLINGTON VT
05401-5046
US

V. Phone/Fax

Practice location:
  • Phone: 802-528-2600
  • Fax:
Mailing address:
  • Phone: 802-598-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0066152
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number101.0066152
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: