Provider Demographics
NPI:1154754141
Name:NASH, TRISTA (MS, ATC, PBT)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:MS, ATC, PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 COCHRANE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3953
Mailing Address - Country:US
Mailing Address - Phone:651-271-4070
Mailing Address - Fax:
Practice Address - Street 1:1387 WILLOW CREEK LN
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8552
Practice Address - Country:US
Practice Address - Phone:651-271-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26452083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine