Provider Demographics
NPI:1235787581
Name:DUFFY, TRISTAN (RN)
Entity Type:Individual
Prefix:MS
First Name:TRISTAN
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TRISTAN
Other - Middle Name:LEE
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1906 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1906 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2942
Practice Address - Country:US
Practice Address - Phone:843-621-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse