Provider Demographics
NPI:1528513215
Name:ROSE, TRISTEN AMBER (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TRISTEN
Middle Name:AMBER
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:TRISTEN
Other - Middle Name:AMBER
Other - Last Name:NOTTAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5402 WESTHEIMER RD STE K
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5302
Mailing Address - Country:US
Mailing Address - Phone:713-877-1479
Mailing Address - Fax:
Practice Address - Street 1:5402 WESTHEIMER RD STE K
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5302
Practice Address - Country:US
Practice Address - Phone:713-877-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily