Provider Demographics
NPI:1356068613
Name:PRISTAS, PAUL MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:PRISTAS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FOUNDERS POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-0704
Mailing Address - Country:US
Mailing Address - Phone:239-734-1699
Mailing Address - Fax:
Practice Address - Street 1:1909 MALLORY LN STE 200
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2842
Practice Address - Country:US
Practice Address - Phone:615-771-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000032806363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health