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General NPI Number Information
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NPI Number | 1003776808
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Entity Type | Individual
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Provider Name | TRISTAN S BOYER RN
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1 CONVENTION AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4311
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Country | US
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Telephone | 215-662-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 WALNUT ST APT A
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN792496
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License Number State | PA
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