Provider Demographics
NPI:1609358951
Name:MARTIN, TRISTA FRANCES (LVN)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:FRANCES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27949 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-4422
Mailing Address - Country:US
Mailing Address - Phone:346-803-0558
Mailing Address - Fax:
Practice Address - Street 1:27949 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-4422
Practice Address - Country:US
Practice Address - Phone:346-803-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181695164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse