Provider Demographics
NPI:1104467562
Name:TRISTAN, SELINA E (APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:E
Last Name:TRISTAN
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6112
Mailing Address - Country:US
Mailing Address - Phone:956-540-5226
Mailing Address - Fax:956-246-4735
Practice Address - Street 1:611 BISHOP ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-0920
Practice Address - Country:US
Practice Address - Phone:956-792-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142157207VX0000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner