Provider Demographics
NPI:1083210199
Name:HUERTA, TRISTA RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:RENEE
Last Name:HUERTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20682 W FOUNDER CIR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7501
Mailing Address - Country:US
Mailing Address - Phone:602-525-1381
Mailing Address - Fax:
Practice Address - Street 1:20682 W FOUNDER CIR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7501
Practice Address - Country:US
Practice Address - Phone:602-525-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily