Healthcare Provider Details

I. General information

NPI: 1538844576
Provider Name (Legal Business Name): TRISTA PRINGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 WESTOVER CIR
SUN PRAIRIE WI
53590-3411
US

IV. Provider business mailing address

828 WESTOVER CIR
SUN PRAIRIE WI
53590-3411
US

V. Phone/Fax

Practice location:
  • Phone: 608-320-4669
  • Fax:
Mailing address:
  • Phone: 608-320-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9052-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: