Provider Demographics
NPI:1801825120
Name:TRIBBLE, SIDENIA SURRATT (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SIDENIA
Middle Name:SURRATT
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 BRALEY POND RD
Mailing Address - Street 2:
Mailing Address - City:WEST AUGUSTA
Mailing Address - State:VA
Mailing Address - Zip Code:24485-2007
Mailing Address - Country:US
Mailing Address - Phone:540-337-6330
Mailing Address - Fax:
Practice Address - Street 1:70 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-221-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164211363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care