Provider Demographics
NPI:1477670040
Name:ISLAND, TRISTAL T (MS)
Entity Type:Individual
Prefix:
First Name:TRISTAL
Middle Name:T
Last Name:ISLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TRISTAL
Other - Middle Name:T
Other - Last Name:THROWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4403
Mailing Address - Country:US
Mailing Address - Phone:870-862-7921
Mailing Address - Fax:870-864-2490
Practice Address - Street 1:715 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4403
Practice Address - Country:US
Practice Address - Phone:870-862-7921
Practice Address - Fax:870-864-2490
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator