=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700260866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRISTAN MICHAEL ERB
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2015
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 OLENTANGY RIVER RD SUITE 5300
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-566-3500
-----------------------------------------------------
Fax | 614-533-0150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 FRANTZ RD SUITE 250
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43016-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-566-3500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.17752
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------