Provider Demographics
NPI:1821346172
Name:CLANTON, TRISTAN (RN)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:CLANTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-7860
Mailing Address - Country:US
Mailing Address - Phone:252-621-0646
Mailing Address - Fax:
Practice Address - Street 1:1541 CHARTER DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-3544
Practice Address - Country:US
Practice Address - Phone:252-621-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse