Provider Demographics
NPI:1184050544
Name:TRIPORO, PETER (ACNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TRIPORO
Suffix:
Gender:M
Credentials:ACNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OAK LAWN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6719
Mailing Address - Country:US
Mailing Address - Phone:214-521-0100
Mailing Address - Fax:214-521-0104
Practice Address - Street 1:3500 OAK LAWN AVE STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-6719
Practice Address - Country:US
Practice Address - Phone:214-521-0100
Practice Address - Fax:214-521-0104
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX758330363LA2100X
TXAP124414363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317773YS7NMedicare Oscar/Certification
TX317773YS7NMedicare UPIN
TX317773YS7NMedicare PIN