MEDICARE: JANA TRISTAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP129171	TX
2	363L00000X	Nurse Practitioner	AP129171	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467823831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA TRISTAN NP

Provider Business Mailing Address
First Line	:	1901 MEDI PARK DR STE 2036
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-2109
Country	:	US
Telephone Number	:	806-468-4625
Fax Number	:	806-468-4626

Provider Business Practice Location Address
First Line	:	1901 MEDI PARK DR STE 2002
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-2108
Country	:	US
Telephone Number	:	806-353-4699
Fax Number	:	806-353-4551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	06/09/2020

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Directions to “ JANA TRISTAN NP” Practice Location

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