Provider Demographics
NPI:1194282111
Name:TRIPP, TINA M (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:TRIPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002-0900
Mailing Address - Country:US
Mailing Address - Phone:719-582-8773
Mailing Address - Fax:
Practice Address - Street 1:1331 PRAIRIE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4867
Practice Address - Country:US
Practice Address - Phone:307-778-3121
Practice Address - Fax:307-637-1558
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994558-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily