Provider Demographics
NPI:1306353834
Name:MCMAHON, TRISTA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:MARIE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:MARIE
Other - Last Name:GESTRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:300 HALKET ST STE 610
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3108
Mailing Address - Country:US
Mailing Address - Phone:412-641-6412
Mailing Address - Fax:
Practice Address - Street 1:300 HALKET ST STE 610
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3108
Practice Address - Country:US
Practice Address - Phone:412-641-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103613680Medicaid