Provider Demographics
NPI:1730144122
Name:RISTAU, TAMMY L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:RISTAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16347
Mailing Address - Country:US
Mailing Address - Phone:814-584-1130
Mailing Address - Fax:814-584-1133
Practice Address - Street 1:511 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:PA
Practice Address - Zip Code:16347-2111
Practice Address - Country:US
Practice Address - Phone:814-584-1130
Practice Address - Fax:814-584-1133
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097056UWFMedicare ID - Type Unspecified
PAQ60235Medicare UPIN