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General NPI Number Information
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NPI Number | 1790268282
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 1901 MEDI PARK DR STE 2036
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City | AMARILLO
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State | TX
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Zip | 79106-2109
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Country | US
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Telephone | 806-468-4317
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 MEDI PARK DR STE 2036
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City | AMARILLO
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State | TX
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Zip | 79106-2109
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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 | OWNER/PROVIDER
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Name | JANA TRISTAN
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Credential | NP
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Telephone | 806-584-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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