Provider Demographics
NPI:1457032864
Name:SOTO, TRISTAN L (RN)
Entity Type:Individual
Prefix:MS
First Name:TRISTAN
Middle Name:L
Last Name:SOTO
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 1:2407 VILLA AT THE WOODS
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4912
Mailing Address - Country:US
Mailing Address - Phone:845-641-9135
Mailing Address - Fax:
Practice Address - Street 1:2407 VILLA AT THE WOODS
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-4912
Practice Address - Country:US
Practice Address - Phone:845-641-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY765803163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty