Provider Demographics
NPI:1861746778
Name:HASBARGEN, TRISTAN MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:MICHAEL
Last Name:HASBARGEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13859
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3859
Mailing Address - Country:US
Mailing Address - Phone:850-877-4134
Mailing Address - Fax:850-402-9130
Practice Address - Street 1:1707 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5317
Practice Address - Country:US
Practice Address - Phone:850-877-4134
Practice Address - Fax:850-402-9130
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant