Provider Demographics
NPI:1518778331
Name:SYPHERD, TRISTYN (FNP-C)
Entity type:Individual
Prefix:
First Name:TRISTYN
Middle Name:
Last Name:SYPHERD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14514 W VENTURA ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5727
Mailing Address - Country:US
Mailing Address - Phone:480-202-3079
Mailing Address - Fax:
Practice Address - Street 1:14514 W VENTURA ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5727
Practice Address - Country:US
Practice Address - Phone:480-202-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF01250695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner