Provider Demographics
NPI:1336894948
Name:ZYLSTRA, TRICIA (FNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 ROYAL COACH TRL
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9434
Mailing Address - Country:US
Mailing Address - Phone:336-406-5858
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPICE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5766
Practice Address - Country:US
Practice Address - Phone:336-768-3972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015774363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care