MEDICARE: TRISTAN JEAN MILONE APRN

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	115668	NE

General Provider Information

NPI Number	:	1619798188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN JEAN MILONE APRN

Provider Business Mailing Address
First Line	:	3821 S 213TH ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-3262
Country	:	US
Telephone Number	:	402-332-6057
Fax Number	:

Provider Business Practice Location Address
First Line	:	11902 PIERCE PLZ
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-1607
Country	:	US
Telephone Number	:	402-502-9868
Fax Number	:

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

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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