Provider Demographics
NPI:1467823831
Name:TRISTAN, JANA (NP)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:TRISTAN
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 1:1901 MEDI PARK DR STE 2036
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2109
Mailing Address - Country:US
Mailing Address - Phone:806-468-4625
Mailing Address - Fax:806-468-4626
Practice Address - Street 1:1901 MEDI PARK DR STE 2002
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2108
Practice Address - Country:US
Practice Address - Phone:806-353-4699
Practice Address - Fax:806-353-4551
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129171363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358670306Medicaid